Clinical Vignette XIV

• Which of the following set of characteristics best describes the most likely bacterial pathogenic cause of this patient’s clinical signs and symptom?

A 24-year-old female is evaluated in the medtigo Medical Clinic for a 2-day history of worsening dysuria with increased urinary frequency and urgency. She denies any associated fever, flank pain, gross hematuria, vaginal discharge, or urinary incontinence. The patient reports experiencing similar symptoms about four months ago which resolved after she completed an antibiotic treatment course of Trimethoprim-Sulfamethoxazole prescribed to her by a clinician at the ACME Urgent Care Center. The patient reports recently breaking up with her boyfriend of 3 years and reports being sexually active with 5 different male partners in the past 4 months. She also admits to not always using a condom. She drinks alcohol socially on the weekends, occasionally smokes cigarettes when drinking alcohol but denies the use of recreational drugs. She has never been tested for HIV or any other sexually transmitted infections. Her current medications are prescribed oral contraceptive pills and over the counter phenazopyridine. She has no known allergies. The rest of her medical history, social history, and family history is unremarkable.

On physical examination, vital signs are normal. There is mild suprapubic tenderness to palpation. There is no costovertebral angle tenderness bilaterally. The remainder of the physical examination is unremarkable. The pelvic examination deferred. A urinalysis and urine gram stain with microscopy performed in the clinic reveals the following results:

• Which of the following mechanisms of action best describes the most clinically appropriate antimicrobial treatment for this patient’s medical condition?

• In addition to prescribing an appropriate course of antibiotics for the patient’s medical condition, which of the following is the least appropriate next step in management of this patient’s routine health maintenance?