Critical Care Medicine-Infections and Immunologic Disease>>>>>Genitourinary Infection
Question 3#

A 78-year-old woman with diabetes and hypertension presents to the emergency department with confusion and hypotension. A urinalysis is notable for a white blood cell count of >100,000 and is positive for leukocyte esterase. Urine culture subsequently grows >100,000 Pseudomonas aeruginosa, resistant to ciprofloxacin. You begin appropriate antibiotic therapy with a beta-lactam antibiotic.

For how long should she be treated?

A. 3 to 5 days
B. 5 to 10 days
C. 10 to 14 days
D. Until her confusion resolves

Correct Answer is C

Comment:

Correct Answer: C

This patient has an acute complicated urinary tract infection. Patients presenting with complicated urinary tract infections should have urine culture performed to confirm the microbiologic cause of the infection and antimicrobial susceptibility of the pathogen(s) causing the infection. Total antibiotic duration depends on the antibiotic class used to treat the infection. Fluoroquinolones are given for 5 to 7 days, trimethoprim/sulfamethoxazole for 7 to 10 days, and beta lactams for 10 to 14 days. Longer durations may be appropriate for patients with an ongoing nidus of infection (eg nonobstructing stone).

References:

1. van Nieuwkoop C, van der Starre WE, Stalenhoef JE, et al. Treatment duration of febrile urinary tract infection: a pragmatic randomized, double-blind, placebo-controlled non-inferiority trial in men and women. BMC Med. 2017;15(1):70. Epub 2017 Apr 3.
2. Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012;366(11):1028-1037.