Patient Case: 56-year-old male with multiple myeloma

Cedars-Sinai Medical Center

Academic medical center in Los Angeles, CA

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ESBL Urosepsis Patient

56-year-old male with multiple myeloma, complicated course, recently started on lenalidomide, a chemotherapy agent that leads to immune suppression. Admitted to hospital for low back pain and urinary retention. Diagnosed with UTI; urine and blood cultures obtained.

Empiric therapy Levofloxacin (IV), then changed to piperacillin-tazobactam when Gram stain showed GNR
ID/AST method Accelerate PhenoTest® BC kit
ID result Escherichia coli
AST results All cephalosporins resistant and meropenem MIC <=0.25 mcg/ml
Therapy change Escalation to meropenem
Time to AST results ∼7h post +BC with Accelerate PhenoTest BC kit

Case Discussion

Microbiology CLS notified Stewardship pharmacist of AST result and the pharmacist then immediately communicated with the physician the ID and final MIC susceptibility results. MD accepted therapy escalation to meropenem. Acceptance of pharmacy interventions using the Accelerate Pheno® system MIC results has been 100%. Previously, our acceptance rate had been 82% with ID and resistance marker information.

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