Management of Pseudomonas Urinary Tract Infections (UTIs) in the Context of Extensive Antibiotic Anaphylaxis: A Case-Based Perspective

This case report discusses a 56-year-old African American woman with a history of recurrent urinary tract infections (UTIs) and repeated anaphylactic reactions to multiple antibiotics. She presented with dysuria and foul-smelling urine but denied fever or catheter use. Notably, she had a recent hospitalization for methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) skin infection of the scalp. Physical examination revealed right costovertebral angle (CVA) tenderness. Urine dipstick showed positive nitrites and large leukocyte esterase. Culture identified <i>Pseudomonas aeruginosa </i>(<i>P. aeruginosa</i>), sensitive to several intravenous antibiotics, including aztreonam. Due to her extensive antibiotic allergies, she was referred to the emergency department, where she received IV aztreonam with resolution of her symptoms. This case highlights the clinical challenge of managing <i>Pseudomonas</i> UTIs in patients with limited antibiotic options and underscores aztreonam as a valuable therapeutic alternative in such settings. It also emphasizes the importance of individualized antibiotic oversight in patients with complex allergies.