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Complicated urinary tract infection with ESBL risk — ABIM Board MCQ

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HardInfectious DiseaseComplicated urinary tract infection with ESBL riskABIM Board

A 74-year-old woman from a nursing facility has fever, flank pain, leukocytosis, and hypotension. Prior urine cultures grew ESBL-producing E. coli. Urinalysis shows pyuria and bacteriuria. Which of the following is the most appropriate management?

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Correct answer: A — Empiric carbapenem therapy while cultures are pending

Septic complicated UTI with prior ESBL organism warrants empiric therapy active against resistant gram-negative pathogens, often a carbapenem, guided by prior cultures, local antibiogram, severity, allergies, and renal function. Nitrofurantoin and single-dose fosfomycin are inadequate for pyelonephritis or sepsis.

Reference: IDSA 2025 Complicated Urinary Tract Infection Guideline