Review Question - QID 109553

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Urinary Tract Infections Epidemiology Risk factors QID: 109553 (M2.RL.17.4867)

QID 109553 (Type "109553" in App Search)

A 26-year-old woman presents to the emergency department for shortness of breath. She was walking up a single flight of stairs when she suddenly felt short of breath. She was unable to resolve her symptoms with use of her albuterol inhaler and called emergency medical services. The patient has a past medical history of asthma, constipation, irritable bowel syndrome, and anxiety. Her current medications include albuterol, fluticasone, loratadine, and sodium docusate. Her temperature is 99.5°F (37.5°C), blood pressure is 110/65 mmHg, pulse is 100/min, respirations are 24/min, and oxygen saturation is 85% on room air. On physical exam the patient demonstrates poor air movement and an absence of wheezing. The patient is started on an albuterol nebulizer. During treatment, the patient's saturation drops to 72% and she is intubated. The patient is started on systemic steroids. A Foley catheter and an orogastric tube are inserted, and the patient is transferred to the MICU. The patient is in the MICU for the next seven days. Laboratory values are ordered as seen below.

Hemoglobin: 11 g/dL
Hematocrit: 33%
Leukocyte count: 9,500 cells/mm^3 with normal differential
Platelet count: 225,000/mm^3

Serum:
Na+: 140 mEq/L
Cl-: 102 mEq/L
K+: 4.0 mEq/L
HCO3-: 24 mEq/L
BUN: 21 mg/dL
Glucose: 129 mg/dL
Creatinine: 1.2 mg/dL
Ca2+: 10.1 mg/dL
AST: 22 U/L
ALT: 19 U/L

Urine:
Color: amber
Nitrites: positive
Leukocytes: positive
Sodium: 12 mmol/24 hours
Red blood cells: 0/hpf

Which of the following measures would have prevented this patient's laboratory abnormalities?

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Nitrofurantoin

1/73

TMP-SMX

4/73

Sterile technique

22%

16/73

Avoidance of systemic steroids

0/73

Intermittent catheterization

62%

45/73

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This patient is presenting with a urinalysis demonstrating a urinary tract infection. The best preventive measure is intermittent catheterization rather than leaving a Foley catheter in place.

Urinary tract infections (UTIs) are a common complication in the hospital. Catheter acquired UTIs (CAUTIs) typically occur due to longstanding Foley catheter placement. The best preventive measure to avoid CAUTIs is intermittent catheterization. Best practices include only leaving a Foley catheter in for the shortest amount of time needed and switching to intermittent catheterization as soon as possible.

Incorrect Answers:
Answer 1: Nitrofurantoin is an appropriate prophylactic antibiotic and treatment for UTIs in pregnancy; however, it is not a better preventive measure than intermittent catheterization for CAUTIs.

Answer 2: TMP-SMX is an appropriate treatment for a UTI but it is not a better prophylactic measure than intermittent catheterization.

Answer 3: Sterile technique when placing a Foley catheter can reduce UTIs; however, this is less likely to reduce the incidence of UTIs when compared to intermittent catheterization.

Answer 4: Systemic steroids can be immunosuppressive but are crucial to the management of this patient's asthma attack. Intermittent catheterization is a better prophylactic measure.

Bullet Summary:
Intermittent catheterization is the best method to avoid catheter associated urinary tract infections.

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