Patient Case: 66-year-old male patient

University of Arkansas for Medical Sciences

Academic medical center in Little Rock, AR

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Urosepsis De-Escalation Patient

66 yo male admitted at 20:43. Chief complaint is increased urine frequency, fever, chills and abdominal pain. ED vitals: Tmax 39.4°C, HR 130s, RR 14-26, BP 110-120/50-60mmHg. Labs: lactate 3.0, WBC 8.7, UA+LE, >100 WBC, 1500 bacteria. Blood and urine cultures are taken.

Empiric therapy Vancomycin and cefepime are started per Code Sepsis
ID/AST method Accelerate PhenoTest® BC kit
ID result Escherichia coli
AST results Pan-susceptible to all agents tested
Therapy change De-escalation to ceftriaxone
Time to AST results ∼7.4h post +BC with Accelerate PhenoTest BC kit

Case Discussion

Time from positive BC to optimal therapy was 24 hours, and time from positive BC to discharge was 51 hours. Total length of stay for the patient was 65 hours. The blood culture results were back before the urine culture results.

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