A 46-Year-Old Woman Is Admitted for Elective Hysterectomy Due to Abnormal

A 46-year-old woman is admitted for elective hysterectomy due to abnormal uterine bleeding.  The patient has a history of diabetes mellitus and urinary incontinence, and she smoked cigarettes occasionally for years before quitting 5 years ago.  She is prepared for surgery, and an indwelling urinary catheter is placed.  The surgery is completed without complications and the patient is transferred to the hospital ward for recovery.  The indwelling catheter is kept in place for the next 72 hours. The patient subsequently develops a fever of 39 C (102.2 F) , along with suprapubic and costovertebral angle tenderness.  Urine culture shows >10⁵ colony-forming units/mL of extended-spectrum, beta-lactamase-producing Escherichia coli.  Which of the following is the most important risk factor for this patient's infection?

A) Comorbid diabetes mellitus
B) Duration of catheterization
C) Female sex
D) History of smoking
E) Urinary incontinence

Correct Answer:

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