Patient Case: Urosepsis Patient With Pyelonephritis

San Cecilio University Hospital

Academic medical center in Granada, Spain

Urosepsis Patient With Pyelonephritis

72-yo male presented to emergency unit with fever for four days, hypogastric pressure, discomfort during urination. He indicated shivering that persisted despite taking acetaminophen. He also indicated a pain that radiated from the left lumbar area to the left groin. He had no respiratory symptoms. He reported having mild diarrhea the morning that he presented at the emergency unit.

Empiric therapyCeftriaxone (2g IV)
ID/AST methodAccelerate PhenoTest® BC kit
ID resultEscherichia coli
AST resultsResistance to ampicillin, clavulanic amoxicillin and Intermediate sensitivity to cefazolin
Therapy changeTherapy continued
Time to AST results∼7h after BC+
Patient outcomePatient was hemodynamically stable and afebrile.

Case Discussion

A 72-year-old man presented to the emergency unit. He reported having a fever beginning four days earlier, as well as voiding symptoms including hypogastric pressure and discomfort during urination. He indicated shivering that persisted despite taking acetaminophen. He also indicated a pain that radiated from the left lumbar area to the left groin. He had no respiratory symptoms. He reported having mild diarrhea the morning that he presented at the emergency unit. He self-medicated with amoxicillin/clavulanic at home, without a doctor’s prescription.

Analytical results: Urine: nitrites ++++, WBC +++, RBC +++. Blood: creatinine 0.81. CRP 106, procalcitonin 4.92; haemoglobin 11.1gr/dl, WBC 11310 (92.7% PMN), platelets 135,000. Temperature: 38.2° C. Abdomen: soft, depressible, discomfort to deep palpation in hypogastrium.

Urine and blood culture were requested by the emergency unit doctor, with a presumptive diagnosis of sepsis secondary to pyelonephritis. Samples arrived at our lab at 18:32 and blood culture bottles were immediately loaded onto the BD Bactec™ 9240 system. Urine was cultured on sheep blood agar (Biomerieux) and URI4 (Bio-Rad™). While at the emergency unit ceftriaxone (2gr iv) + paracetamol (iv) + 500cc saline iv was administered (20:30). Blood culture bottles become positive at 04:31 the day after admission, 11 hours after they were loaded. At 7:00 am Escherichia coli was identified, and by 11:00am MIC and SIR results were available to the emergency care doctors (‘Resistance’ to ampicillin, clavulanic amoxicillin and ‘Intermediate’ sensitivity to cefazolin). Antimicrobial therapy was continued, together with hydration and general care measures. The patient was hemodynamically stable and afebrile.

“One of the advantages of providing round-the-clock microbiology services is the ability to immediately act on positive results, whether they are delivered at 4pm or 4am. The Accelerate Pheno system is very easy to use, which allows technicians to operate the instrument at any time of the day. This case illustrates the importance of the clinical microbiology laboratory in providing timely results, which aids rapid patient treatment. At our facility, we were able to provide 24/7 responses and give the treating physician results in the fastest way possible. For us, the ability to process blood culture using an FDA-cleared technology that has minimal hands-on-time and an easy-to-use procedure is crucial. The Accelerate Pheno system provides this and has certainly met our expectations.” —Federico García García, PharmD, PhD, Head of the Microbiology and Parasitology Clinical Unit and Natalia Chueca, PhD, Clinical Microbiologist, Microbiology Department

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