SAQ 227 – Infectious Diseases and Obstetrics – resistant UTI in pregnancy

Review Completed

Marked out of 12.00

During routine pathology follow-up, you review an MSU result from a patient seen two days earlier: a 35-year-old woman at 15 weeks' gestation with left flank pain and dysuria, no allergies, prescribed trimethoprim, and follow-up as required. The result is shown below.

Test	Result	Reference / sensitivity
Leucocytes	>1,000 x 10^6/L	<2 x 10^6/L
Red blood cells	220 x 10^6/L	<13 x 10^6/L
Squamous epithelial cells	+
Culture	Escherichia coli >10^9 cfu/L
Ampicillin	Sensitive
Augmentin	Sensitive
Cefotaxime	Sensitive
Cephalothin	Sensitive
Cotrimoxazole	Sensitive
Gentamicin	Sensitive
Nitrofurantoin	Sensitive
Trimethoprim	Resistant

Other than confirmed UTI, state four (4) clinical problems.

(Marked out of 4.0)

/ 4

Complete the table with four (4) key actions and one justification for each.

(Marked out of 8.0)

Investigation	Justification
1.
2.
3.
4.

/ 8

Total Score: 0 / 12

Percentage: 0%

Action	Justification
Contact and recall the patient immediately.	She requires urgent reassessment and appropriate treatment.
Open disclosure.	Best practice, supports understanding, and may reduce subsequent legal conflict.
Clinical reassessment with urgent IV antibiotics and likely admission.	Minimises further maternal and fetal harm.
Obstetric review.	Specialist follow-up is required after potentially teratogenic exposure and infection in pregnancy.
Quality-improvement or root-cause review and debrief.	Identify knowledge or system gaps and reduce recurrence.
Document all actions.	Supports ongoing care and addresses legal implications.

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