Monitoring and discharge therapy – case 6 part 1

The following case is an example of the monitoring which may be required:

A 62-year-old patient, prescribed clinically significant immunosuppressive therapy for a severe inflammatory condition, is treated for bloodstream infection and pyelonephritis due to an extended-spectrum beta-lactamase (ESBL) producing E. coli (also cultured from urine).

The patient is initially treated in hospital and is then transferred to the OPAT service for ongoing outpatient intravenous therapy, following which the patient is switched to an oral antibiotic.

You review the patient at the end of this – by which time they have made an excellent recovery.

On questioning you note that this is the patient’s fourth symptomatic urinary tract infection in the last 12 months (since commencing immunosuppressive therapy, which cannot be reduced or stopped at this time). Renal imaging is normal. You recommend to the patient’s primary care physician that they are commenced on long-term Pivmecillinam to which previous urinary isolates have been susceptible.

Nine months later, the patient presents with a 3-month history of progressive exhaustion and muscle weakness.

What blood test is most likely to reveal the cause for the patient’s symptoms?

A) Folic acid

B) Carnitine

C) Liver enzymes

D) Creatinine

Please comment your answer below, and discuss with other learners.