Catheter-associated urinary tract infection Quiz: Ace Your Exams

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An 80-year-old woman is brought to the emergency department from a nursing facility due to altered mental status. Over the past few days, the patient has been confused and agitated. Medical history is notable for prior cerebral infarction, leaving the patient largely bedbound and incontinent of urine and stool. Temperature is 39.0 °C (102.2 °F), blood pressure is 120/80 mmHg, and pulse is 90/min. The patient winces when the suprapubic region is palpated. There is no costovertebral angle tenderness. A urinary catheter is in place. According to notes from the nursing home, the catheter was placed two weeks ago to manage the patient’s urinary incontinence. Serum creatinine is 0.7 mg/dL (reference range: 0.6-1.2 mg/dL). Urinalysis shows 15-20 WBC/hpf (reference range: ≤5 WBC/hpf) and 0-3 RBC/hpf (reference range: ≤5 RBC/hpf). Urine and blood cultures are obtained. Which of the following is the most likely diagnosis?

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