A 42-year-old woman with a 10-year history of systemic lupus erythematosus presents to the emergency department with a 3-day history of dysuria, frequency, and left flank pain. She denies vaginal discharge or previous urinary tract infections. Temperature is 39.1°C, blood pressure 126/80 mmHg, heart rate 104/min, and respiratory rate 18/min. Urinalysis shows leukocyte esterase positive, nitrite negative, pH 8.2, and 18 WBCs/hpf with no bacteria on Gram stain. Urine culture grows a gram-negative rod that is oxidase negative, lactose non-fermenting, hydrogen sulfide positive, and produces a characteristic musty/earthy odor on agar plates. Blood cultures remain sterile after 48 hours. Which organism is most likely responsible for this patient's pyelonephritis?
- A)Pseudomonas aeruginosa
- B)Klebsiella pneumoniae
- C)Proteus mirabilisGABARITO
- D)Serratia marcescens
- E)Escherichia coli
Explicação
Proteus mirabilis is a gram-negative, lactose non-fermenting rod that produces hydrogen sulfide and has characteristic features including a musty odor, high urease activity (explaining alkaline urine pH 8.2), and mucoid/swarming appearance on agar. It is a com... Ver explicação completa e trilha adaptativa →