Patient Case: Septic Shock Patient Requiring Escalation

San Giovanni Addolorata Hospital

Academic medical center in Rome, Italy

Septic Shock Patient Requiring Escalation

63-yo female was admitted to ER due to severe urinary sepsis. History of metastatic bladder cancer, peripherally inserted central catheter line, on-going therapy with cortisone.

Empiric therapyCiprofloxacin
ID/AST methodAccelerate PhenoTest® BC kit
ID resultEscherichia coli
AST resultsCeftazidime (S), piperacillin-tazobactam (S), meropenem (S), colistin (S)
Therapy changeEscalation to meropenem
Time to AST results7h 2min
Patient outcomePatient improved and was discharged 17 days after being admitted to the ER and diagnosed with septic shock

Case Discussion

A 63-year-old female was admitted to emergency room due to severe urinary sepsis. History of metastatic bladder cancer, peripherally inserted central catheter line, on-going therapy with cortisone.

Analytics results: Lactic acid level: 2.34 mmol/L, qSOFA (≥2): 3, SOFA (≥2): 6; 4600 WBC, 82.9% neutrophils, CRP 14.6mg/dL, creatinine 0.6mg.dL, NA 148mEq/L, K 2.95mEq/L, Cl 119mEq/L, Ca 7.3mg/dL.

Patient received initial therapy of ciprofloxacin. The Accelerate Pheno® system identified the organism as Escherichia coli and provided susceptibility results in 7h 2min. Patient therapy was escalated to meropenem. Patient improved and was discharged 17 days after being admitted to the ER and diagnosed with septic shock.

“For septic shock patients, the Accelerate Pheno system was very effective to obtain not only a rapid and accurate microbiological diagnosis, but also to optimize antimicrobial therapy within the context of antimicrobial stewardship principles.” —P.M. Placanica, P. Carfagna, S. Lauri, M. Gaudio; oral presentation at ECCMID 2019.

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