E. coli UTI, many negatives

CC: burning with urination, weakness. HPI: 79F with HTN, HLD, hypothyroidism, osteoporosis, depression, GERD, brought by daughter for 5 days of dysuria, frequency and suprapubic discomfort. PCP started nitrofurantoin 3 days ago; symptoms worse despite adherence, now with low-grade temps and generalized weakness. Daughter reports she is at her cognitive baseline, no acute confusion. Denies hematuria. Denies flank pain. No history of UTIs. No catheter. ROS: + dysuria, frequency, suprapubic pain, weakness. Denies nausea, vomiting, diarrhea, chest pain, SOB, cough, back pain. Vitals: T 37.8, HR 92, RR 16, BP 134/76, SpO2 97% RA. Exam: MMM. Mild suprapubic tenderness. No CVA tenderness bilaterally. Lungs clear. A&O x3. Labs: WBC 11.2. Hgb 12.4. Na 138, K 3.7, BUN 24, Cr 0.9 (baseline 0.9). Lactate 1.2. UA: LE 3+, nitrite +, WBC >50/hpf, RBC 3-5/hpf, bacteria many, no WBC casts. MDM: UTI failing outpatient oral therapy in a frail 79F. Does not meet SIRS; sepsis not suspected. No evidence of pyelonephritis clinically. Urine cx sent. Ceftriaxone 1 g IV. Admit for IV abx pending culture.

HPI: As per ED. 79F with 5 days of dysuria/frequency, worse despite 3 days of outpatient nitrofurantoin. PMH: HTN, HLD, hypothyroidism, osteoporosis, depression, GERD. No diabetes. No kidney disease. Meds: hydrochlorothiazide 12.5 mg, simvastatin 20 mg, levothyroxine 75 mcg, alendronate 70 mg weekly, sertraline 50 mg, famotidine 20 mg BID. Allergies: NKDA. Social: lives with daughter, ambulates with cane, no tobacco. Exam: T 37.6, HR 86, BP 130/72. Mild suprapubic TTP. No CVA tenderness. No focal neuro deficits. Mood euthymic. Assessment/Plan: 1. Urinary tract infection - ceftriaxone 1 g IV daily, f/u urine culture. No evidence of pyelonephritis (afebrile, no flank pain, no CVA tenderness). Sepsis not suspected - vitals stable, lactate normal. No evidence of AKI - Cr at baseline. Renal US to exclude obstruction given failure of outpatient therapy. 2. HTN - continue HCTZ. 3. HLD - continue simvastatin. 4. Hypothyroidism - continue levothyroxine. 5. Osteoporosis - hold alendronate inpatient, resume at discharge. 6. Depression - continue sertraline; stable. 7. GERD - continue famotidine. DVT ppx: enoxaparin. Code: Full.

EXAM: US renal, complete. FINDINGS: Right kidney 10.2 cm, left kidney 10.6 cm. Normal cortical echogenicity. No hydronephrosis. No calculi. No perinephric fluid. Bladder partially distended with mild diffuse wall thickening, no intraluminal mass. IMPRESSION: No hydronephrosis or renal abscess. Mild bladder wall thickening, which may be related to underdistension or cystitis.

S: Dysuria improving, feels stronger, walked with PT. O: T 37.1, HR 78, BP 138/78. No CVA tenderness. WBC 8.4, Cr 0.8. Urine culture: >100,000 CFU/mL Escherichia coli, susceptible to ceftriaxone, cefazolin, nitrofurantoin, ciprofloxacin; no resistance identified. Renal US: no hydronephrosis. A/P: 1. E. coli UTI - improving on ceftriaxone; transition to PO cephalexin tomorrow if continues to do well. No evidence of upper tract involvement. 2. HTN - controlled on HCTZ. 3. HLD, hypothyroidism, osteoporosis, depression, GERD - stable.

Shift summary: Afebrile, VSS (T 36.9, HR 76, BP 132/74). Voiding without difficulty, reports burning "much better", urine clear yellow, no visible blood. No flank or back pain reported. Ambulated in hall x2 with cane and standby assist, steady gait. Fall precautions maintained, bed alarm on. Taking PO well, ate 75% of dinner. Daughter at bedside, updated on plan to switch to oral antibiotic tomorrow.

Admit: 09/19/2026 Discharge: 09/22/2026 Discharge diagnoses: 1. Urinary tract infection due to E. coli (pan-susceptible) 2. Hypertension 3. Hyperlipidemia 4. Hypothyroidism 5. Age-related osteoporosis 6. Depression 7. GERD Pertinent negatives: no evidence of pyelonephritis; no CVA tenderness; denies hematuria; sepsis not suspected; no AKI; no hydronephrosis on US. Hospital course: 79F admitted with dysuria and frequency failing outpatient nitrofurantoin. UA consistent with infection; urine culture grew pan-susceptible E. coli. Treated with IV ceftriaxone x3 days with resolution of symptoms, transitioned to cephalexin. Ambulating at baseline with cane at discharge. Discharge meds: cephalexin 500 mg BID x4 days; resume alendronate; continue HCTZ, simvastatin, levothyroxine, sertraline, famotidine. Follow-up: PCP 1 week.