Urinary Tract Infection: Patient Case Study Analysis and Management

This report presents a detailed analysis of a urinary tract infection (UTI) case study involving an 18-year-old patient presenting with symptoms of urinary urgency, frequency, dysuria, and turbid urine. The report explores the patient's clinical history, risk factors, and the principles behind laboratory tests, including urine dipstick tests for nitrites and leukocyte esterase, and urine culture and sensitivity (M/C/S) tests. The results of these tests are interpreted, and further testing methods are discussed. The report also covers the treatment and management of the patient, including the use of antibiotics and self-management strategies. The importance of quality assurance and control in microbiological testing is also highlighted, emphasizing the need for accurate and reliable results in diagnosing and treating UTIs. The report concludes with a discussion on the appropriate antibiotics and management approaches for the patient's condition, providing a comprehensive overview of the diagnosis and treatment of UTIs.

Running head: URINARY TRACT INFECTION
URINARY TRACT INFECTION
Name of the student
Name of the university
Author’s name

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Quality assurance and quality control and its importance
Quality assurance and quality control in the microbiological context refers to the control
of errors and accuracy of results in the performance of tests which can be achieved by
maintaining and controlling the quality following a set of standard operating procedures (SOPs).
These standards include guidelines or principles to facilitate an effective and accurate
performance of tests without any error (Who.int 2020). The responsibility of quality analyst is
thus to monitor that the laboratory facilitates an air conditioned and dust free environment, all the
technical personal and the supervisors are well qualified and have adequate skills, knowledge
and expertise and the laboratory must take part in both external and internal quality assurance
schemes (Scherz, Durussel and Greub 2017).
Patient’s clinical history
As per the case study, an 18 year old patient was presented to the General Practitioner
(GP) with a two day history of urinary urgency with an increased frequency. Furthermore, she
has been experiencing dysuria and fatigue more recently. Also, her urine is turbid and foul-
smelling. However, she encountered no vaginal discharge. Thus, from these above symptoms, it
is evident that the patient might be suffering from Urinary Tract Infection (UTI). Patients with
UTI generally have medical history of previous UTI, a family history of UTI and other comorbid
conditions like diabetes and kidney disorders, however, no such medical history has been
observed in the case study. The patient, conversely, on enquiry stated that she has become
sexually active recently with a partner and took protection with condoms having spermicide as
contraception. Studies have shown that sexual intercourse using spermicide coated condoms

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increases the risk of UTI among women. This is because sexual intercourse and spermicide
exposure are significant risk factors for UTI. The common symptoms for UTI include urinary
urgency and frequency, dysuria and fatigue which were evident in the 18 year old patient.
Patient’s risk factors
The patient was sexually active with a partner recently which might have contributed to
an increased risk for UTI. Spermicide used as a method of contraception are significant risk
factors for developing UTI. The risk of UTI increases with more frequent use of spermicide
coated condoms and thus, the patient in the case study is an increasing risk for UTI which she
was suspected with (Bergamin and Kiosoglous 2017). Also, young women who are sexually
active are at risk for developing Urinary tract infection (Mohiuddin 2019). There are a numerous
risk factors for UTI, however, the case study does not provide such information on the patient’s
medical and social history. Thus, it is difficult to interpret the exact risk factors for her current
condition. Therefore, the risk factors for this patient are being sexually active and using
spermicide condoms as contraception (Storme et al. 2019).
Principles of each laboratory results
Urine specimen of the patient was collected for conducting urine test. A urine dipstick
test has been performed to detect nitrites and leukocyte esterase for urinalysis. Generally, in
healthy people, both leukocyte esterase and urine nitrite test results are negative. However,
negative test results of nitrite do not indicate that the urine is free from bacteria, provided there
are clinical symptoms since there are many bacteria that do not produce nitrites. The presence of
leukocyte esterase in the urine indicates the presence of white blood cells. However, this test is

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also used for screening amniotic fluid infections and gonorrhea. The combination of this test
along with the nitrite test are used to diagnose and detect UTI. Urine sample with nitrite and
leukocyte esterase test provides an excellent screening method for diagnosing UTI. Urine sample
with positive for both leukocyte esterase and nitrite must be cultured for pathogenic bacteria
(Chung et al. 2018). Thus, for this patient leukocyte esterase and nitrite was positive which
indicated UTI and therefore, her sample was sent to the laboratory for performing M/C/S.
Specimen required for each test
For performing a dipstick urinalysis, the urine specimen is dipped with a plastic strip
treated with chemicals. When the chemicals on the stick react and change its color, it indicates
certain characteristics and medical condition that patient is suffering from. A dipstick test is a
basic routine urinalysis used for determining the pathological changes in the urine in standard
urinalysis. The trip consist of 10 chemicals or reagents that reacts with the urine. For diagnosing
Urinary Infections, nitrites and leukocytes test results are positive. The patient in the case study
is having UTI that might have caused by Escherichia coli., which is the most common gram
negative bacteria for UTI followed by Enterobacter spp., Klebsiella spp., and others. The
presence of leukocyte esterase is confirmed by the violet colored dye produced due to its
catalyzing activity in the hydrolysis of an ester of indoleccarboxylic acid. The indoxyl which is
liberated mixes with a diazonium salt for producing the violet colored azole dye. When the
results are positive, the urine specimen is sent to the microbiology laboratory for conducting
urine microbe cultural sensitivity tests that detect the causal bacteria for the infection (Suresh et
al. 2017). The M/C/S test further guides the treatment process and helps in intervening the
appropriate antibiotic for the treatment of the patient. Urine sample is cultured on culture plates

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containing solid media and then incubated for 24 hours and then observed for the causal bacteria
which is further confirmed by other tests. After conducting the culture sensitivity test the
antibiotics are determined that will be given to the patient (Rowe and Juthani-Mehta 2014).
Results provided
The results of the dipstick test indicated positive result for leukocyte esterase and nitrites
implicating the medical condition of UTI. In a urine sample, it is usual to find at least 3 or
sometimes 5 leukocytes per high power field (40X) in women diagnosed with vaginal
contamination. However, the presence of a higher number implicates UTI. The dipstick test for
urine is conducted that helps in detecting leukocyte esterase present in azurophilic granules of
monocytes and granulocytes like neutrophilic, basophilic and eosinophilic (Duanngai, Sirasaporn
and Ngaosinchai 2017). Nitrite test is a rapid test used for detecting the possible infections
caused by nitrate reducing bacteria. Some of the common gram negative bacteria include E. coli,
enterobacter spp., klebsiella spp., Citrobacter spp. and Proteus spp. that have enzymes that
reduce the nitrate in urine to nitrite and that is why the presence of nitrite in the urine indicate
UTI which was evident in the patient in the case study (Rowe and Juthani-Mehta 2014).
Further testing required
After confirmation of the urine dipstick test, the urine sample is sent for further testing in
the microbiology laboratory which gives detailed information about the causal organism and also
directs the treatment process. The urine sample taken in the laboratory is streaked using an
inoculation loop on CLED (Cystine-Lactose-Electrolyte-Deficient) Agar plate for isolating the
bacteria from urine. CLED agar plates are commonly used agar plates for urine culture because it

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supports the growth and development of urinary pathogens and contaminants while preventing
undue swarming of Proteus species because of the lack of electrolytes (Akter, Haque and Salam
2014). MacConkey agar are also used for urine culture for the detection of gram negative
bacteria since it inhibits the growth of gram positive bacteria because of the concentration of bile
salts. After that the inoculated pates are incubated for 24 hours and observed under the microbes
which are further confirmed by various tests for gram positive and gram negative bacteria
followed by culture sensitivity test using various antibiotics (Akter, Haque and Salam 2014).
Treatment and management of the patient
The treatment and management of UTI depends on the severity or the complexity of the
disease. At the initial stage, the affected individual is given with oral antibiotics (Tan and
Chlebicki 2016). Antibiotics are the first line of treatment for UTI and the antibiotics are
prescribed depending upon the causal bacteria found in the urine sample. However, for treating
simple UTIs some of the common antibiotics that are prescribed include
 Trimethoprim/sulfamethoxazole (Bactrim, Septra, others)
 Nitrofurantoin (Macrodantin, Macrobid)
 Cephalexin (Keflex)
 Ceftriaxone
 Fosfomycin (Monurol)
The treatment and management of UTI also include some self-management strategies and home
remedies such as drinking plenty of water since water helps in flushing out the urine and also the
bacteria and avoiding the intake of alcohol and other substance (Kang et al. 2018). For women
who are sexually active and have UTI, postictal prophylactic antibiotic can be found to be

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effective in preventing infections. Self-initiated antibiotics are also found to be beneficial for
women with frequent recurrent infections. Thus, this patient in the case study can be treated
following the above ways and approaches (Barber et al. 2013).

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