Lessons for life - Cultures before antibiotics

A middle-aged lady with diabetes mellitus admitted to the medical casualty ward with a high fever. She also complained of dysuria and left-sided loin pain.

She had dysuria for the past one week and had taken treatment from a private practitioner. She was given oral cefuroxime for 7 days. But she had stopped taking treatment after 3 days as her dysuria got better. two days later she developed a high-grade fever with chills and rigors with loin pain and vomiting.

On examination, she was ill and dehydrated. The pulse rate was 120/min. Her blood pressure was 90/60mmHg. There was marked left side renal angle tenderness.

Diagnosis - Left-sided pyelonephritis with shock in a patient with diabetes mellitus
After initial resuscitation and antibiotics, she made a good recovery.

Blood culture yielded E. coli which was only sensitive to meropenem.


Lessons
  • Never ever prescribe an antibiotic without taking proper cultures!
  • Always prescribe the correct antibiotic, in the correct dose, for the correct duration.
  • Make sure the patient will adhere to the regime.
  • If the patient is managed as an outpatient it's always good to review a patient after 48 hours to assess the response to treatment.
  • Infections in a patient with diabetes can be fatal if not properly treated.
  • If the patient is ill, always admit.
  • For blood sugar control in ill patients never use oral hypoglycemic agents. Always go for soluble insulin.
Homework 
  • Read about the acute management of sepsis. 'The sepsis bundle'.
  • Read about the organisms which cause urinary tract infections.




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