Patient Case: 17-year-old-male-with-acute-lyphoblastic-leukemia

University Hospital Policlinico of Catania

Academic medical center in Catania, Italy

Fever in a Young Oncohematological Patient

A 17-year-old male with a previous diagnosis of acute lymphoblastic leukemia was admitted to our Emergency Room for suspected acute pancreatitis.

Empiric therapy Fluconazole, vancomycin and meropenem
ID/AST method Accelerate PhenoTest® BC kit
ID result Acinetobacter baumannii
AST results Amikacin (R), ciprofloxacin (R), meropenem (R), trimethoprim/sulfamethoxazole (R), colistin (S)
Therapy change Escalation to include colistin
Time to AST results 6h 30min
Patient outcome Vital parameters normalized, and fever disappeared

Case Discussion

A 17-year-old male with a previous diagnosis of acute lymphoblastic leukemia was admitted to our Emergency Room for suspected acute pancreatitis. A C-reactive protein (CRP) value of 286.52 mg/L and a procalcitonin (PCT) value of 4.53 ng/ml, together with fever (T=38.5°C) and tachycardia, led clinicians to the suspicion of sepsis.

Empiric treatment with fluconazole, vancomycin and meropenem was started, while peripheral vein and central catheter blood cultures were collected. Blood cultures became positive within 8 hours and an extemporary Gram-stain revealed Gram-negative coccobacilli.

Identification and antibiotic susceptibility test (AST) with Accelerate PhenoTest® BC kit were performed. Identification results were obtained within 1 hour and 30 minutes: the presence of Acinetobacter baumannii was detected. A susceptibility panel was produced within 6 hours and 30 minutes.

With these results, clinicians were able to optimize antibiotic treatment: fluconazole and vancomycin were suspended, while meropenem was maintained with the addition of colistin. The patient’s clinical condition improved: vital parameters normalized, and fever disappeared, even while inflammation indices remained high (CRP=269.46 mg/L and PCT=12.51 ng/ml).

The use of the Accelerate PhenoTest® BC kit favored better management of therapy, allowing a reduction of selective pressure from unnecessary and potentially toxic drugs in a patient strongly compromised by his basic oncological diagnosis. The identification and susceptibility results were also confirmed by alternative routine laboratory methods, but the time to pathogen identification and antibiotic susceptibility requires was considerably longer (additional 5.5-14 hours).

Furthermore, newer broad-spectrum antibiotics were tested later using Gradient-test analysis. Unfortunately, although the therapy adjustment, the patient’s comorbidities were excessively severe and he died of multi-organ failure after a 5-day stay in the intensive care unit.

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