Risk factor(s) for UTI Demonstrated

          Risk factors for a UTI this patient is demonstrating include being female of child-bearing years and ongoing symptoms for 5 months with the fourth visit for continued symptoms. Having continued symptoms include urinary frequency and dysuria. Prior antibiotic use is a common risk factor. Continued risk includes the urine specimen revealing cloudiness, alkaline pH, increased nitrates, leukocyte esterase, mucous, and bacteria. Other risk factors include the use of a diaphragm and spermicide for birth control. Previous gram-positive cocci on her urine current culture are different from her previous culture. Streptococcus agalactiae, otherwise known as group B Streptococcus (GBS) is a Gram-positive B-hemolytic chain-forming coccus that is a common asymptomatic inhabitant of the lower gastrointestinal and female reproductive tracts. GBS is estimated to cause approximately 1-2% of all monomicrobial UTIs (Kline & Lewis, 2016).

Differential diagnoses for this patient

         Differential diagnoses for this patient include vaginitis or urethritis from an untreated STI due to the type of contraceptive use that does not include a condom for the protection of STIs but a diaphragm for the prevention of pregnancy, possible untreated STI, and change in cervical mucosa pH flora from irritant contact with the spermicidal agent. Other organisms such as Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, and Ureaplasma urealyticum are typically STIs that can suggest UTI etiology (Akram et al., 2020).

Additional medication management

          Additional medication management to consider for GBS are several options. Clindamycin, vancomycin, penicillin, cephalexin, and cefdinir. Antibiotic treatment that shows resistance to GBS includes ciprofloxacin, levofloxacin, gentamicin, azithromycin, TMP/SMX, metronidazole, and doxycycline. Some of those are commonly prescribed and recommended as a first choice before culture results if they are done.

Full prescription details

          Full prescription details include amoxicillin/clavulanate 500 mg orally twice daily for 7 days. #14. No refills. May be taken with light meals for increased absorption, and fewer GI effects.

Patient Education

          Patient education to consider would be to use protection such as a condom and not a spermicidal agent or diaphragm for sexual intercourse. Maintaining good hydration, good hygiene, urinating and wiping from front to back after sexual activity, and taking in vaccinium macrocarpon (cranberry) juice may help to present and treat recurrent UTIs.

Follow-up care for this patient

           Follow-up care for this patient would include taking the full prescription as directed and getting urine re-evaluated after a full course of antibiotics is taken.

Complicated or uncomplicated UTI

          A recurrent UTI refers to the occurrence of more than two symptomatic episodes within 6 months or more than three symptomatic episodes within 12 months (Storme et al., 2019). This patient has no functional or structural impairments known from the case study that would impair the efficacy of antimicrobial therapy. I would consider this case an uncomplicated recurrent UTI due to multiple pathogens identified.

Differences in treatment

          Complicated UTI treatment includes infections with a structural or functional impairment that reduces the efficacy of the chosen therapy. Complicated UTIs also may involve the kidneys such as pyelonephritis or occur during pregnancy. They may also require long antimicrobial therapy compared to uncomplicated UTIs. They also required a referral to urology.

          Uncomplicated UTIs occur in otherwise healthy patients with no structural or anatomical impairments and who are not pregnant.

Management change based on knowledge

          Knowing the differences between a complicated and uncomplicated UTI based on this patient scenario and having an uncomplicated reoccurring UTI does not change the management.

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