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INTRODUCTION

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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

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PATIENT PRESENTATION

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Chief Complaint (from Patient's Wife)

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"He is not acting like himself … he seems really confused."

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History of Present Illness

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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.

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Past Medical History

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History of acute kidney injury, resolved 6 months ago

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HTN

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Past Surgical History

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Kidney abscess (intrarenal), s/p drainage with pigtail catheter 6 months ago

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Right knee surgery in 1974

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Family History

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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.

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Social History

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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.

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Allergies/Intolerances/Adverse Drug Events

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NKDA

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Medications

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Fluoxetine 10 mg PO daily

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Esomeprazole 40 mg PO daily

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Review of Systems

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(+) Fever; (+) vomiting; (−) eye changes; (−) complaints of chest pain or shortness of breath

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Physical Examination

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General
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Acutely ill male with decreased level of consciousness who is sleepy but arousable and able to answer yes and no questions

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Vital Signs
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BP 102/56 mm Hg, P 108, RR 24, T 38.3°C, saturation 100% (1.0) on a nonrebreather mask

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Weight 154 lb (70 kg)

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Height 69 in. (175 cm)

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Skin
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Dry appearing skin; (−) rashes or lesions

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HEENT
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PERRLA, EOMI, head normocephalic, mucous membranes dry

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