Title : Gram-negative sepsis by multidrug-resistant hafnia alvei in a 76-year-old man with multiple sclerosis and neurogenic bladder
Abstract:
This case report describes a 76-year-old male with multiple sclerosis and neurogenic bladder who presented with altered mental status and a recent history of diarrhea. Despite empiric antibiotics, fluids, and vasopressors, the patient deteriorated. Subsequently, positive Polymerase Chain Reaction (PCR) results for Clostridium difficile (C. difficle) prompted adjusting antibiotics. However, the patient's clinical status exhibited no improvement, and blood cultures remained unyielding. This case ultimately unveiled a diagnosis of gram-negative sepsis originating from a Urinary Tract Infection (UTI) caused by multidrug-resistant Hafnia alvei. This report emphasizes the significance of considering unusual pathogens, particularly in patients with neurogenic bladder and immunocompromised conditions, remaining vigilant for multidrug resistance patterns, and the limitations of using PCR as the sole diagnostic test for C. diff, potentially leading to incorrect diagnoses. Tailoring antibiotic therapy based on culture and sensitivity results is essential in achieving favorable patient outcomes.
Audience Take Away:
- This case demonstrates the imperative requirement for conducting a comprehensive septic workup in patients displaying altered mental status and indications of systemic inflammation, even in the absence of an immediately identifiable source of infection.
- In the case of urinary tract infections, it focuses on the critical importance of contemplating atypical pathogens and being vigilant for multidrug resistance patterns to ensure appropriate management and favorable patient outcomes.
- Additionally, it serves as a reminder of the necessity for antibiotic stewardship, advocating for the judicious use of antibiotics to combat the growing threat of antibiotic resistance.
- Furthermore, it highlights the limitations of relying solely on PCR for detection of Clostridium difficle, which lacks specificity in distinguishing between colonization and active infection, underscoring the importance of combining it with other diagnostic tools for more precise clinical decisions.
