At a surgical intensive care unit, a 56 year old diabetic man with a complicated 7×6 cm bed sore (on antibiotic therapy) developed nausea, vomiting and raise in temperature the other night. The intensivist on rounds the next morning noted a temperature of 102°F, patient complaining of fever with shaking chills and a heart rate of 110/minute, respiratory rate 22/min and BP recorded 90/60mm Hg.
Serial blood cultures were sent to the laboratory.
The consultant microbiologist was called up for to discuss concerning the case, the intensivist added previous similar cases over the past two weeks with a note on rapid UTI development in patients on prolonged catheterization within the unit.
Cultures from samples taken from 4 such patients isolated Gram negative (pleomorphic) cocco-bacilli arranged in singles or in pairs.
non hemolytic colonies on Blood agar
non lactose fermenting pale colonies on MacConkey agar
Biochemical reactions;
Oxidase negative
Catalase positive
Indole negative
Urease negative
Citrate Positive
TSI: Alkaline slant/ Alkaline butt with no gas
AST revealed resistance to Beta lactams and Aminoglycosides.
The patient was started on Piperacillin-tazobactam (ie., with a Beta lactamase inhibitor) shortly after which signs of recovery were observed.