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Enterococcus faecalis
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Escherichia coli
Klebsiella pneumoniae
Proteus mirabilis
Staphylococcus saprophyticus
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This patient presenting with worsening suprapubic discomfort and pain, dysuria, slightly acidic urine, and positive urinary leukocyte esterase and nitrites has acute cystitis (a urinary tract infection (UTI)). The most common cause of UTIs is Escherichia coli. E. coli is a gram-negative, facultatively anaerobic bacillus that normally colonizes the gastrointestinal tract. It also has fimbriae, a virulence factor that allows it to adhere to and ascend the urinary tract. Because women have a shorter urethra than men (and thus less distance for the bacterium to ascend to reach the bladder), women are at an increased risk for UTIs compared to men. Patients with a UTI often present with dysuria, suprapubic discomfort, urinary frequency, and urinary urgency. Patients with acute cystitis can present without systemic signs of infection such as a fever. The treatment for an uncomplicated UTI may include antibiotics such as nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin, all of which cover E. coli. Mao et al. studied the E. coli genes that are associated with UTIs in humans. The authors found multiple genes, such as sisA and sisB, that are associated with UTIs. They recommended that further research be performed on these genes as potential therapeutic targets for the prevention of UTIs. Incorrect Answers: Answer 1: Enterococcus faecalis is a gram-positive colonizer of the gastrointestinal tract. Proper hand hygiene after using the bathroom can help prevent the spread of Enterococcus infections and inoculation of the urinary tract. Enterococcus UTIs are difficult to treat because these species are usually resistant to multiple antibiotics. Answer 3: Klebsiella pneumoniae is a gram-negative, facultatively anaerobic bacillus that is a common cause of uncomplicated UTI. K. pneumoniae is also commonly found in the gastrointestinal tract and infections can be prevented with proper hand hygiene. K. pneumoniae can also cause pneumonia, which presents with fever, cough, and sputum production. The sputum can appear blood-streaked, in a "currant jelly" pattern and is more commonly seen in patients with alcohol use disorder. Answer 4: Proteus mirabilis is a gram-negative, facultatively anaerobic, urease positive bacillus that is found in the gastrointestinal tract and can cause UTIs. Under microscopy, it exhibits swarming motility. Because of its urease activity, Proteus mirabilis alkalinizes the urine, leading to formation of staghorn calculi. This can be seen on ultrasound or a computed tomography (CT) scan of the kidneys. Answer 5: Staphylococcus saprophyticus is a gram-positive coccus that is a common cause of uncomplicated UTIs, especially in sexually-active women. S. saprophyticus normally colonizes the perineum, urethra, cervix, and gastrointestinal tract. Bullet Summary: The most common cause of urinary tract infections is Escherichia coli.
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