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LEARNING OBJECTIVES

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 PRESENTATION

Chief Complaint

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.”

HPI

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.

PMH

Gout

Diabetes mellitus

Resistant hypertension

Influenza pneumonia

FH

Both parents are deceased (mother age 88 of PE; father age 71 of stroke). He is married without any children.

SH

Retired steel mill worker and union chief, distant history of tobacco and alcohol use with no current use

Meds

Metformin 1000 mg PO BID

Glyburide 5 mg PO daily

Spironolactone 25 mg PO daily

Lisinopril 40 mg PO Q HS

Amlodipine 10 mg PO daily

Allopurinol 300 mg PO daily

All

Penicillin: hives when he was a child

Morphine: itching

ROS

Patient’s primary complaint is of nausea and dizziness, but due to current status, unable to review further.

Physical Examination

Gen

The patient is clearly fatigued and appearing in respiratory distress.

VS

BP 108/58, P 108, RR 36, T 39°C; Wt 64.2 kg, Ht 68″

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