Catheter-associated urinary tract infection Quiz: Ace Your Exams

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A 78-year-old man is brought from a nursing facility to the emergency department due to suprapubic pain and burning with urination. Symptoms started two days ago and have progressively worsened. Medical history is notable for hypertension, chronic obstructive pulmonary disease, and a prior lower spinal cord injury that has left the patient paralyzed below the waist. Temperature is 38.7 °C (101.7 °F), blood pressure is 148/90 mmHg, pulse is 90/min, and respiratory rate is 16/min. On physical examination, there is tenderness to palpation in the suprapubic region. There is no costovertebral angle tenderness. A chronic indwelling urinary catheter is in place. The serum leukocyte count is 18,000/mm³. Urinalysis shows 10-15 WBC/hpf and 0 RBC/hpf. Blood and urine cultures are obtained and sent to the lab. Which of the following is the next best step in managing this patient?

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Await urine culture results

Place bilateral percutaneous nephrostomy tubes

Initiate ceftriaxone therapy

Initiate piperacillin-tazobactam therapy

Obtain non-contrast CT of the abdomen and pelvis