A 20-year-old pregnant woman (gravida II, para I) complains of lower pelvic discomfort, fever, and pain during urination for the past 2 days. She also reports seeing blood in her urine. In the patient, which of the following would be the most likely etiologic agent?
**Core Concept**
The patient's symptoms, including lower pelvic discomfort, fever, pain during urination, and hematuria, are suggestive of a urinary tract infection (UTI). The most likely etiologic agent would be a bacterium that commonly causes UTIs, particularly in pregnant women.
**Why the Correct Answer is Right**
In pregnant women, the risk of UTIs increases due to changes in the urinary tract, including ureteral dilation and vesicoureteral reflux. The most common causative organism of UTIs in this population is Escherichia coli (E. coli), a gram-negative rod that can adhere to the bladder and urinary tract epithelium, leading to infection. Other organisms, such as Klebsiella pneumoniae and Enterococcus faecalis, can also cause UTIs, but E. coli is the most common.
**Why Each Wrong Option is Incorrect**
**Option A:** Group B streptococcus (GBS) is a common cause of neonatal sepsis and pneumonia but is not typically associated with UTIs in pregnant women.
**Option B:** Staphylococcus saprophyticus is a common cause of UTIs in sexually active young women, but it is not the most likely etiologic agent in this patient, who is pregnant.
**Option C:** Pseudomonas aeruginosa is an opportunistic pathogen that can cause UTIs, particularly in patients with underlying urinary tract abnormalities or immunocompromised states. However, it is not the most common cause of UTIs in pregnant women.
**Clinical Pearl / High-Yield Fact**
Pregnant women with UTIs are at increased risk of developing pyelonephritis, a serious complication that can lead to preterm labor and other maternal and fetal complications. Prompt diagnosis and treatment of UTIs in pregnant women are essential to prevent these complications.
**Correct Answer:** C. Escherichia coli.