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After completing this case study, the reader should be able to:
Discuss the possible etiology of bacterial disease following a viral illness such as influenza.
Discuss the use of rapid diagnostic testing methods that help differentiate bacterial species as well as determine organism-specific antibiotic resistance profiles.
Evaluate culture and sensitivity results, and determine the clinical significance of the minimum inhibitory concentration.
Design an evidence-based care plan to treat a bloodstream infection based on laboratory information.
Recommend a plan for monitoring efficacy and adverse effects of an antimicrobial therapy regimen.
Patient’s wife states of her husband, “Lately he has not been acting like himself. He has been very dizzy, tired, and has not been eating or drinking well.”
Jordan Zimmerman is a 68-year-old man who came to the ED via ambulance. The patient’s history is obtained from his wife. She describes a change in mental status, lethargy, and shortness of breath, along with a significant decrease in activity and nutritional intake. Over the past 24 hours he has become very nauseated and developed a fever (39°C). The symptoms started 3 days ago and have progressively worsened. He was seen by his primary care physician 6 days ago (last week) and determined to have a positive influenza-A nasal swab. He was prescribed oseltamivir and recently completed his 5-day treatment course.
Both parents are deceased (mother age 88 of PE; father age 71 of stroke). He is married without any children.
Retired steel mill worker and union chief, distant history of tobacco and alcohol use with no current use
Spironolactone 25 mg PO daily
Amlodipine 10 mg PO daily
Allopurinol 300 mg PO daily
Penicillin: hives when he was a child
Patient’s primary complaint is of nausea and dizziness, but due to current status, unable to review further.
The patient is clearly fatigued and appearing in respiratory distress.
BP 108/58, P 108, RR 36, T 39°C; Wt 64.2 kg, Ht 68″