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Targeted antimicrobial therapy for urinary sepsis: Case #2

In this step we explore the antimicrobial therapy options for Bill Jenkins.
Hand with pills

Mr Jenkins was administered meropenem 2g TID and amikacin 1g QD.

Forty-eight hours later he still has a high temperature but his overall clinical condition and the analytical data show frank improvement. No alternative source of infection has been found and his urine and blood cultures have come back positive with a phenotypically identical E. coli in both.

Blue table with three columns: Antibiotic/MIC (ug/mL)/Interpretation. There are 14 antibiotics listed with their MIC and Susceptibility or Resistance noted

The question now is how would you continue antimicrobial therapy?

There are several options but before going into the therapeutic options let’s summarise the case:

  • Mr Jenkins had a (severe) urinary sepsis and we have good evidence of the etiological agent: an ESBL-producing E. coli.

  • Although he is still febrile, the clinical course is favourable.

  • No evidence of abscess or urinary obstruction has been found.

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Challenges in Antibiotic Resistance: Gram Negative Bacteria

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