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Review Question - QID 106729

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QID 106729 (Type "106729" in App Search)
A 22-year-old sexually active female presents to the emergency department in severe pain. She states that she has significant abdominal pain that seems to worsen whenever she urinates. This seems to have progressed over the past day and is accompanied by increased urge and frequency. The emergency room physician obtains a urine dipstick which demonstrates the following:

Urine:
Specific gravity: 1.010
Leukocyte esterase: Positive
Protein: Trace
pH: 7.2
RBC: Negative
Nitrite: Negative.

A urease test is performed which is positive. What is most likely cause of UTI in this patient?

Klebsiella pneumoniae

9%

34/392

Staphylococcus saprophyticus

46%

180/392

Proteus mirabilis

20%

79/392

Escherichia coli

19%

73/392

Serratia marcescens

2%

6/392

Select Answer to see Preferred Response

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This patient presents with a urinary tract infection (UTI). The most common nitrite-negative organism causing UTIs in sexually active women is Staphylococcus saprophyticus.

Urinary tract infections are infections affecting either the lower or upper urinary tract. S. saprophyticus is the second most common organism causing UTIs in sexually active women. Diagnostic markers for UTIs on urine dipstick include positive leukocyte esterase, which indicates a bacterial infection (presence of white blood cells), positive nitrates which indicate infection with gram-negative bacteria (E. coli, K. pneumoniae, and P. mirabilis ), and positive urease which indicates the presence of a urease-producing organism such as S. saprophyticus, Proteus, and Klebsiella. Note that in infection with S. saprophyticus, nitrites would be negative as this is a gram-positive organism.

Incorrect Answers:
Answer 1: K. pneumoniae, P. mirabilis, and E. coli are gram-negative bacteria and would be expected to produce nitrites.
Answer 5: S. marcescens does cause UTIs but is typically nosocomial and is not as common as E. coli, S. saprophyticus, or Klebsiella.

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