Patient Case: 74-year-old patient with multiple myeloma

University of Arkansas for Medical Sciences

Academic medical center in Little Rock, AR

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74-year-old patient with multiple myeloma

74-year-old male admitted at 12:27 for chemotherapy for multiple myeloma. Hospital course included chemotherapy, prophylaxis of acyclovir/levofloxacin/fluconazole. Patient neutropenic. 10 days after admission, Tmax measured at 38.4°C @20:33, WBC 002 (ANC0), HR 100s. Blood and urine cultures obtained.

Empiric therapyVancomycin and meropenem started the next morning
ID/AST methodAccelerate PhenoTest® BC kit
ID resultPseudomonas aeruginosa
AST resultsAmikacin (R), cefepime (R), ceftazidime (R), ciprofloxacin (R), gentamicin (I), meropenem (I), pip-tazo (R), tobramycin (S)
Therapy changeMeropenem escalated to ceftolozane-tazobactam
Time to AST results∼7.4h post +BC with Accelerate PhenoTest BC kit

Case Discussion

Time from positive BC to optimal therapy was 9.7 hours. Due to the MDR report manual testing was able to be added quickly. Ceftolozane-tazobactam susceptibility confirmed 53 hours after positive BC. LOS was long (27 days) due to other conditions. Febrile neutropenic patient on appropriately escalated therapy 24 hours after fever.

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