The patient was a 19-year old female with a history of a urinary tract infection (UTI) 4 months prior to admission for which she was treated with oral ampicillin without complications. Five days prior to this admission she began to note nausea without vomiting. One day later she developed left flank pain, fevers, and chills and noted increased urinary frequency. She noted foul-smelling urine on the day prior to admission. She presented with a temperature of 38.8 °C, and physical examination showed left costovertebral angle tenderness. Urinalysis of a clean-catch urine sample was notable for >50 white blood cells per high-power filed, 3 to 10 red blood cells per high-power field and >3 bacteria. Urine culture was subsequently positive for > 105 CFU of an organism per ml. The bacteria were negative in the Gram-stain and had a rod shape. Growth of the isolate on McConkey agar. The isolate was streaked on the left side of the plate and on the right a control strain was plated The isolate was b-hemolytic when grown on sheep blood agar. Please answer and discuss the following points in complete sentences (no more than 750 words total!).

1) What do the urinalysis findings indicate? Explain your answer.

2) Why was the number of organisms in her urine quantitated on culture? How would interpret the culture results in this case?

3) Did this Gram-negative rod ferment lactose? What other gram-negative behave the same way? Which one is also often beta-hemolytic?