2. The patient was an 80-year-old female who 10 days previously had had a bladde

Question

2. The patient was an 80-year-old female who 10 days previously had had a bladder repair performed. At the time of that hospital admission, a urine culture was obtained that revealed >100,000 bacteria per ml. The bacteria were gram negative rods that fermented lactose when grown on McConkey agar. The bacteria was susceptible to all antimicrobial agents against which it was tested. Postoperatively, she began a 7-day course of oral cephalexin (a beta-lactam class

of antibiotics). She was discharged after an uneventful postoperative course of 3 days. Ten days postoperatively, she presented with a 3-day history of diarrhea. The patient noted multiple, watery loose stools without blood, crampy abdominal pain, and vomiting. She presented with an elevated temperature of 38.20C and an elevated white blood cell count.

A) What organism was probably causing this woman’s UTI? explain your answer..

Explanation / Answer

The organism which was probably causing this women's diarrhoea is Escherichia coli. The urinary tract infection by the bacteria is the most common cause in older women and patient's who had undergone bladder surgery and the one who uses catheter are more prone to the disease. Pyuria or elevated white blood count in urine ( pus greater than 1 per high-power field) is the diagnostic value of the bacteria. Diagnosis can be done by dipstick method to check for the elevated leukocyte esterase. A count of greater than 105 bacteria per ml is significant in a urine sample collected by voiding , suggesting infection. The bacteria is gram negative rod measuring 1-3 × 0.4-0.7 micrometer, arranged singly or in pairs. E.coli can ferment lactose and on MacConkey medium colonies are bright pink in colour. The bacteria is susceptible to beta lactam drugs unless it is a strain with extended spectrum beta lactamase (ESBL) phenotype. Cephalexin being beta lactam and first generation cephalosporin works well against urinary tract infection or UTI. Women are more prone to UTI due to their shorter urethra. The colon and the lower urinary tract especially bladder lie close to each other. It is believed that inflammatory chemicals in the infected portion of urinary tract can act on the colon ; Moreover motile bacteria can be transferred from urinary tract to rectum and all these can lead to diarrhea. E.coli diarrhea has most common symptoms of loose stool with nausea, vomiting and abdiminal cramp. There are 5 different types of diarrheagenic E.coli are recognised : a) enteropathogenic b) enterotoxigenic c) enteroinvasive d) enterohemorrhagic e) enteroaggregative. Further serological tests should be done to identify the strain. UTI can elevate the body temperature too. All of the aforementioned signs and symptoms are suggestive of Escherichia coli UTI infection followed by diarrhea.

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