A patient with symptoms of a UTI has a culture taken, which grows 5x103 E. coli. The laboratory reports it as "insignificant." Which of the following is the most appropriate next step in management?: (A) Consider vancomycin as an alternative drug, (B) Determine if fluorescent microscopy is available for the diagnosis of actinomycosis, (C) Do no further clinical workup, (D) Suggest to the laboratory that low colony counts may reflect infection; follow up with culture
Answer is D. This question demonstrate commonly occurring clinical infectious diseases and microbiologic problems. Enterococci may be resistant to ampicillin and gentamicin. Vancomycin would be the drug of choice. However, laboratory results do not always correlate well with clinical response. The National Committee on Clinical Laboratory Standards recommends testing enterococci only for ampicillin and vancomycin. Some symptomatic patients may have 10 leukocytes per milliliter of urine but relatively few bacteria. The patient is likely infected and the organisms, particularly if in pure culture, should be further processed.