A 64-year-old man comes to the emergency department because of a 2-day history of lower back pain, fever, and chills. He has had nausea but no vomiting during this time. He has hypertension, chronic kidney disease, and type 2 diabetes mellitus. Three months ago, he underwent amputation of his left third toe because of a nonhealing ulcer. He has smoked a pack of cigarettes daily for 48 years. Current medications include hydrochlorothiazide, metoprolol, and insulin. His temperature is 39.4°C (102.9°F), pulse is 102/min, respirations are 18/min, and blood pressure is 150/94 mm Hg. Physical examination shows suprapubic and costovertebral angle tenderness. Urinalysis shows 3+ leukocyte esterase and numerous white blood cells. Urine and blood cultures grow non-lactose-fermenting Gram-negative rods. Which of the following pathogens is the most likely culprit?

Question

A 64-year-old man comes to the emergency department because of a 2-day history of lower back pain, fever, and chills. He has had nausea but no vomiting during this time. He has hypertension, chronic kidney disease, and type 2 diabetes mellitus. Three months ago, he underwent amputation of his left third toe because of a nonhealing ulcer. He has smoked a pack of cigarettes daily for 48 years. Current medications include hydrochlorothiazide, metoprolol, and insulin. His temperature is 39.4°C (102.9°F), pulse is 102/min, respirations are 18/min, and blood pressure is 150/94 mm Hg. Physical examination shows suprapubic and costovertebral angle tenderness.   Urinalysis shows 3+ leukocyte esterase and numerous white blood cells.  Urine and blood cultures grow non-lactose-fermenting Gram-negative rods.  Which of the following pathogens is the most likely culprit?

Quizplus · Accepted Answer

Eductional Objective: Pseudomonas aeruginosa is an oxidase-positive, non-lactose-fermenting, Gram-negative organism.  It is a common cause of urinary tract infections in patients with indwelling bladder catheters.

A 64-Year-Old Man Comes to the Emergency Department Because of a 2-Day