Patient Case: Multidrug-resistant ESBL Patient

University of Greifswald Medicine

Academic medical center in Greifswald, Germany

Multidrug-resistant ESBL Patient

51-yo male transferred from rehabilitation clinic. Sixteen days later the patient showed reduced alertness, a high PCT (>10 ng/l), and a positive urine status (>400 leukocytes/microliter).

Empiric therapyPiperacillin-tazobactam
ID/AST methodAccelerate PhenoTest® BC kit
ID resultKlebsiella pneumoniae
AST resultsMultidrug-resistant, Gram-negative ESBL
Therapy changeEscalation to meropenem
Time to AST results7h after BC+
Patient outcomeImproved alertness, transferred back to rehab clinic.

Case Discussion

A 51-year-old male was transferred from a rehabilitation clinic to the hospital. Sixteen days later the patient showed reduced alertness, a high PCT (>10 ng/l), and a positive urine status (>400 leukocytes/microliter). BCs were prepared and assuming urosepsis, a calculated therapy with piperacillin-tazobactam was started, considering a past colonization with Pseudomonas aeruginosa.

The following day, the BC was positive (09:30am, +0h after positivity) and samples were sent to Clinical Microbiology (CM) diagnostics and simultaneously the Accelerate Pheno® system run was started. Ninety (90) minutes after positivity (11:03am, +1.5h), the Accelerate PhenoTest BC kit identified Klebsiella pneumoniae. One and a half hours later (12:22am, +3h), the CM result (MALDI-TOF mass spectrometry) was available. Seven hours after positivity (04:21pm, +7h), the Accelerate PhenoTest BC kit presented the resistogram identifying 3 multidrug-resistant Gram-negative (MRGN) bacteria and ESBL, and therapy was adjusted to meropenem.

The patient was transferred the same day with improved alertness. The final CM results arrived two days after positivity confirming the resistogram of the Accelerate PhenoTest BC kit results (08:00, +41.5h).

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