Patient Case: 67-year-old patient with diabetes

Sapienza University of Rome

Academic medical center in Rome, Italy

ESBL Sepsis Patient

67 yo female admitted to hospital in confused state. Recent history of ischemic heart disease with myocardial infarction, diabetes mellitus, and hypertension. White blood cell count of 26000 x 109/L and all were neutrophils, creatinine 1.4 mg/dL, CRP 10.4 mg/L, glycemia 49 mg/dl, NaCl 126 mmol/L.

Empiric therapyCeftazidime (2g x 3) and fluconazole (800mg 1st day, 400 mg/d thereafter)
ID/AST methodAccelerate PhenoTest® BC kit, in parallel with traditional methods
ID resultEscherichia coli
AST resultsCeftriaxone (R), ceftazidime (R), piperacillin-tazobactam (S), meropenem (S)
Therapy changeEscalated to meropenem
Time to AST results∼7.5h post +BC with Accelerate PhenoTest® BC kit

Case Discussion

A 67-year-old female with was admitted to the hospital in confused state. The patient had a recent history of ischemic heart disease (15 days prior) with elevation myocardial infarction, diabetes mellitus, and hypertension. The patient was treated with a Β-blocker, anticoagulant, aspirin, statins, pantoprazole, antihypertensive, diuretics, canrenone, regular and slow insulin. Laboratory results showed a white blood cell count of 26.000 x 109/L and all were neutrophils, creatinine 1.4 mg/dL, CRP 10.4 mg/L, glycemia 49 mg/dl, NaCl 126 mmol/L. The patient was given ceftazidime (2 gr x 3) and fluconazole (800 mg on the first day, followed by 400 mg/d). Gram staining was performed, blood culture (BC) was incubated and showed positivity at 5:15am on Day 1.

Pathogen identification (ID) and antimicrobial susceptibility testing (AST) was initiated, in parallel, using the Accelerate Pheno system and conventional methods. Accelerate Pheno system ID results were available on Day 1 at 12:58pm and Accelerate Pheno system AST results were available on Day 1 at 18:25. The conventional methods results were available on Day 3 and Day 4, respectively. ID results for both conventional methods and Accelerate Pheno system revealed the presence of Escherichia coli. For both methods, AST results showed resistance (R) for ceftriaxone and ceftazidime, and susceptibility (S) for both piperacillin-tazobactam and meropenem. After results were obtained, it was determined that the patient was on inappropriate and inactive antimicrobials. Therapy was optimized to meropenem (1 gr x 4).

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