Lower urinary tract infection Quiz: Ace Your Exams

A 68-year-old man with a history of hypertension presents to the emergency department with an episode of acute decompensated heart failure. He is admitted to the ICU for management and monitoring. An indwelling urinary catheter is placed for urine output monitoring. On day 5 of hospitalization, the nurse reports that his urine appears cloudy with normal urine output. The patient reports chills and lower abdominal pain. He does not complain of low back pain. His temperature is 38.9°C (102.0 F), blood pressure is 92/64 mm Hg, pulse is 114/min, respiratory rate is 22/min, and oxygen saturation is 96% on 5L nasal cannula. Physical examination is significant for suprapubic tenderness. There is no costophrenic angle tenderness. Laboratory results are significant for leukocytosis and an elevated CRP. Urinalysis shows pyuria and is positive for nitrites and leukocyte esterase. IV fluids are initiated. Urine and blood cultures are obtained. Which of the following is the most appropriate next step in management?