Patient Case: Febrile Patient With Leukemia

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 therapyMeropenem, daptomycin, tigecycline
ID/AST methodAccelerate PhenoTest® BC kit
ID resultKlebsiella pneumoniae
Therapy changeMeropenem, tigecycline, colistin, fosfomycin
AST resultsMeropenem (S), colistin (S), aminoglycosides (S), all others R
Time to AST results7h 28min
Patient outcomePatient afebrile on Day 4

Case Discussion

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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