CASE LEARNING OBJECTIVES
Recognize the common signs and symptoms of complicated urinary tract infections (UTIs)
Describe factors that may affect empiric therapy for complicated UTIs
Develop an appropriate plan for treatment of a complicated UTI
Evaluate factors that may decrease risk of recurrent complicated UTIs
Chief Complaint (from Patient's Wife)
"He is not acting like himself … he seems really confused."
History of Present Illness
Joseph Jones is a 74-year-old resident of an assisted-living facility who is transferred to ABC Medical Center due to altered mental status. Initial differential diagnosis includes bacteremia, sepsis from a urinary source, UTI, or meningitis. On the basis of diagnostic studies including a chest x-ray and CT scan along with laboratory data, it is determined that the patient's altered mental status is due to a complicated UTI and dehydration from acute N/V. The patient is started on ciprofloxacin 200 mg IV q12h.
History of acute kidney injury, resolved 6 months ago
Kidney abscess (intrarenal), s/p drainage with pigtail catheter 6 months ago
Right knee surgery in 1974
Mother died at the age of 68 and had a past medical history significant for HTN and type 2 diabetes mellitus. Father died at the age of 72 and had a past medical history significant for COPD. Patient has 2 children and 5 grandchildren, none with any significant medical history.
Patient and his wife are currently residents of an assisted-living facility. They moved to this facility 4 years ago after his wife's hip replacement. As per the patient's wife, he does not smoke or drink alcohol.
Allergies/Intolerances/Adverse Drug Events
Fluoxetine 10 mg PO daily
Esomeprazole 40 mg PO daily
(+) Fever; (+) vomiting; (−) eye changes; (−) complaints of chest pain or shortness of breath
Acutely ill male with decreased level of consciousness who is sleepy but arousable and able to answer yes and no questions
BP 102/56 mm Hg, P 108, RR 24, T 38.3°C, saturation 100% (1.0) on a nonrebreather mask
Dry appearing skin; (−) rashes or lesions
PERRLA, EOMI, head normocephalic, mucous membranes dry