Policlinico Umberto I Hospital
Academic medical center in Rome, Italy
Febrile Patient With Leukemia
52-yo male with acute myeloid leukemia M3 (acute promyelocytic leukemia) in consolidation phase presented to the hospital with fever
|Empiric therapy||Meropenem, daptomycin, tigecycline|
|ID/AST method||Accelerate PhenoTest® BC kit|
|ID result||Klebsiella pneumoniae|
|Therapy change||Meropenem, tigecycline, colistin, fosfomycin|
|AST results||Meropenem (S), colistin (S), aminoglycosides (S), all others R|
|Time to AST results||7h 28min|
|Patient outcome||Patient afebrile on Day 4|
A 52-year-old male with acute myeloid leukemia M3 (acute promyelocytic leukemia (APL)) in consolidation phase presented to the hospital with fever. Empiric treatment included meropenem, daptomycin, and tigecycline.
Blood was drawn and incubated, and Gram staining was performed. BC showed positivity at 20:00 on Day 1. Pathogen identification (ID) and antimicrobial susceptibility testing (AST) was initiated, in parallel, at 10:30am on Day 2 using the Accelerate Pheno system and conventional methods. Accelerate Pheno system ID results were available on Day 2 at 11:58am and Accelerate Pheno system AST results were available on Day 2 at 17:28. The conventional methods, MALDI-TOF for ID and VITEK 2 for AST results, were available on Day 3 and Day 5, respectively. ID results revealed the presence of Klebsiella pneumoniae. AST results showed susceptibility (S) to meropenem, colistin, and aminoglycosides, and resistance (R) to other antibiotics. Patient was de-escalated and daptomycin was discontinued; meropenem and tigecycline were continued. The outcome resulted in the patient becoming afebrile at Day 4.
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