A urine culture is indicated in all of the following case scenarios EXCEPT:
A. 68-year-old female who has had 3 UTIs in the past 2 months and presents with dysuria, frequency, and 2+ leukocyte esterase on dipstick
B. 4-year-old afebrile female with dysuria, 1+ blood and trace protein on dipstick
C. 41-year-old sexually active male with urinary hesitancy, perineal pain, chills, and 1+ leukocyte esterase on dipstick
D. 22-year-old sexually active female with urinary urgency, dysuria, no vaginal symptoms, a negative pregnancy test, and 3+ leukocyte esterase on dipstick
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Answer: D. Cases A and C represent complicated UTIs. The patient in case A is at high risk of treatment failure due to antibiotic resistant bacteria because she is presenting with recurrent UTIs. UTIs in males are complicated by definition and urine culture should be included in the evaluation. Urine culture is still the gold standard for pediatric patients (case C) and is recommended in all pediatric UTIs. Simple, nonrecurrent cystitis in a nonpregnant, nonmenopausal female patient is an uncomplicated UTI and can be treated without the need for urine culture.