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Proteus mirabilis
1%
2/190
Klebsiella pneumoniae
2%
4/190
Escherichia coli
74%
141/190
Staphylococcus saprophyticus
18%
34/190
Enterobacter cloacae
3/190
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This patient presents with a urinary tract infection (UTI); the most common causative organism is Escherichia coli. E. coli is the most common cause of UTIs, followed, in order, by S. saprophyticus and K. pneumoniae. Diagnostic markers for UTIs include positive leukocyte esterase which indicates a bacterial infection (presence of white blood cells), positive nitrates which indicate infection with gram negative bacteria, and positive urease which indicates the presence of a urease producing organism such as Proteus and Klebsiella. Additionally, a basic pH (6.5-8) commonly indicates infection with a urease producing organism. Mehnert-Kay reviews the diagnosis and management of uncomplicated UTIs. She states most urinary tract infections occur in women who are sexually active, with far fewer cases occurring in older women, those who are pregnant, and in men. E. coli is the leading cause of urinary tract infections, followed by S. saprophyticus. Trimethoprim-sulfamethoxazole has been the standard therapy for urinary tract infection; however, E. coli is becoming increasingly resistant to commonly used medications. Simati et al. review dipstick urinalysis for the diagnosis of acute UTI. They state that dipstick urinalysis moderately improves the accuracy of clinical symptoms in establishing or excluding the diagnosis of acute UTI in women. A positive nitrite test is more useful than a positive leukocyte esterase test, although both increase the odds of a UTI diagnosis. If nitrite and leukocyte esterase tests are negative, the odds of a UTI decrease by 40 to 60 percent. Illustration A describes the pathogenesis and characteristics of a UTI. Illustration B demonstrates a diagnostic and treatment algorithm for UTIs. Incorrect Answers: Answer 1: P. mirabilis is a urease-producing organism and thus would be expected to produce alkaline urine and have a urease positive test. Answer 2: K. pneumoniae is a urease-producing organism and thus would be expected to produce alkaline urine and have a urease positive test. Answer 4: S. saprophyticus would be nitrate negative and urease positive, it is only the second most common organism causing UTI. Answer 5: E. cloacae does cause UTI but is typically nosocomial and is not as common as E. coli.
3.8
(4)
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