Catheter-Associated Infection: A 72-Year-Old Woman With Renal Disease
Ankita Subedi, MBBS, MD | Hospitalist, Aurora BayCare Medical Center, Green Bay, Wisconsin
A 72-year-old woman presents to your emergency department (ED) with fever, weakness, fatigue, and suprapubic abdominal discomfort of 4 days’ duration. Hi
Her medical history is significant for obstructive uropathy, bilateral hydronephrosis, recurrent urinary tract infections (UTIs), stage 3 chronic kidney disease (CKD), and anemia of CKD. She had undergone ureteroscopy and ureteral stent placement for bilateral obstructive ureteral stones with subsequent removal 1 week prior to presentation to the ED.
At presentation, the patient was febrile with a temperature of 38.0 °C, had hypotension with a blood pressure of 128/67 mm Hg, had tachypnea with a respiratory rate of 23 breaths/min, and had tachycardia with a heart rate of 103 beats/min. Her oxygen saturation was 95% on room air.
A physical examination was significant for suprapubic tenderness and bilateral costovertebral angle tenderness.
Results of diagnostic testing revealed an elevated white blood cell count of 12,900/mcL, a low hemoglobin level of 12.5 g/dL, a low platelet level of 281000/mcL, an elevated serum creatinine level of 1.79 mg/dL, a significantly reduced glomerular filtration rate of 28 mL/min/1.73m2, and an elevated lactic acid level of 40mg/dL. Her electrolyte level and results of a liver function test were within normal limits.
A microscopic urinalysis was significant for 3+ leukocyte esterase and a red blood cell count of more than 100 cells/high power file (hpf) with many bacteria, but results were negative for nitrite.
A computed tomography scan conducted in the ED showed worsening bilateral hydronephrosis and hydroureter, bilateral calculi with perinephric stranding, and free fluid. Intravenous fluid was started as per sepsis protocol. Blood and urine cultures were sent for analysis.
A review of the most recent urine culture from one month prior to presentation revealed pansensitive Enterococcus faecalis. The patient was then admitted to the hospital with the diagnosis of sepsis caused by a complicated UTI.