From the Guidelines
This 55-year-old female with metastatic cancer has a urinalysis strongly suggestive of a urinary tract infection (UTI) and possible underlying urothelial cancer, given her age and metastatic cancer history, and should be started on empiric antibiotic therapy immediately and undergo further evaluation for urothelial cancer. The key findings include positive nitrites, leukocyte esterase (500 WBCs/mcL), elevated WBCs (599/HPF), moderate bacteria, WBC clumps, hazy appearance, and trace blood.
- She should be started on empiric antibiotic therapy, typically with trimethoprim-sulfamethoxazole (Bactrim DS) one tablet twice daily for 5-7 days, or nitrofurantoin (Macrobid) 100mg twice daily for 5-7 days, as suggested by general principles of UTI treatment 1.
- If she has impaired renal function, ciprofloxacin 250mg twice daily for 3-5 days would be an alternative.
- A urine culture should be collected before starting antibiotics to identify the specific organism and its antibiotic sensitivities.
- Given her cancer history, she may be immunocompromised, making prompt treatment essential to prevent progression to pyelonephritis or sepsis.
- She should increase fluid intake and be monitored for fever, flank pain, or worsening symptoms.
- If symptoms don't improve within 48-72 hours, her antibiotic regimen may need adjustment based on culture results.
- Further evaluation for urothelial cancer should include office cystoscopy, urine cytology, and imaging of the upper tracts, as recommended by the American College of Radiology 1.
- The patient's risk factors for urothelial cancer, such as age and metastatic cancer history, should be taken into account when determining the extent of evaluation and treatment.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Urine Test Results
The patient's urine test results show several abnormal values, including:
- Color: Yellow (abnormal)
- Clarity: Hazy (abnormal)
- Specific Gravity: 1.005 (within normal range)
- pH: 6.0 (within normal range)
- Leukocytes: 500 WBCs/mcL (abnormal)
- Nitrite: Positive (abnormal)
- Protein: 10 mg/dL (abnormal)
- Glucose: Normal
- Ketones: Negative
- Urobilinogen: Normal
- Blood: 1+ (abnormal)
- Bilirubin: Negative
- RBC: 25 /HPF (high)
- WBC: 599 /HPF (high)
- Bacteria: Moderate (abnormal)
- WBC Clumps: Moderate (abnormal)
- Squamous Epithelial: Rare (abnormal)
- Mucus: Rare (abnormal)
Possible Diagnosis and Treatment
Based on the urine test results, the patient may have a urinary tract infection (UTI) 2, 3, 4, 5, 6. The presence of leukocytes, nitrite, and bacteria in the urine suggests a bacterial infection. The patient's symptoms and test results should be evaluated by a healthcare professional to determine the best course of treatment.
Treatment Options
The treatment of UTIs typically involves antibiotics, and the choice of antibiotic depends on the type of bacteria causing the infection and the patient's medical history 2, 3, 4, 5, 6. Some common antibiotics used to treat UTIs include:
- Nitrofurantoin
- Trimethoprim-sulfamethoxazole
- Fosfomycin
- Fluoroquinolones (such as ciprofloxacin)
- Cephalosporins (such as cephalexin)
Considerations
When selecting an antibiotic, healthcare professionals should consider factors such as the patient's allergies, medical history, and the potential for antibiotic resistance 2, 3, 4, 5, 6. It is also important to note that the patient has metastatic cancer, which may affect their immune system and increase their risk of infection. Therefore, the patient's treatment plan should be individualized and monitored closely by a healthcare professional.