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Acute pyelonephritis — MCCQE Part 1 MCQ

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ModerateDysuriaAcute pyelonephritisMCCQE Part 1

A 31-year-old non-pregnant woman presents with fever, flank pain, dysuria and nausea. Urinalysis is positive for nitrites and leukocytes; she is tachycardic but normotensive. Which of the following is the most appropriate next step?

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Correct answer: D — Obtain urine culture and start empiric antibiotics appropriate for pyelonephritis

Fever and flank pain indicate pyelonephritis, requiring urine culture and prompt systemic antibiotics. Waiting for culture risks progression, while single-dose fosfomycin is for selected uncomplicated cystitis, not pyelonephritis. Antifungal therapy does not address bacterial upper urinary tract infection.

Reference: AMMI Canada antimicrobial stewardship resources; provincial UTI guidance