This is a case-record blog of a 65 year old woman with diabetes for 15 years and recurrent urinary tract infection since few months. It has been created by Dr Deepika Agrawal, Junior Resident, LNMCH, Bhopal by uploading images of the patient's paper based records and reports (after de-identifying the data as per the HIPAA guidelines here:http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528047/figure/fig1/
The problem highlighted here is the urinary infection due to ESBL resistant E coli >10(to the power 5) CFUs which is persistently grown on culture in spite of treating the patient with drugs that demonstrate in-vitro sensitivity. There is also a peculiar finding noted when the E Coli was initially sensitive to Septran (resistant to everything else although not labeled ESBL) but on next testing after a month became resistant to Septran but sensitive to Norflox (see images of the reports below) and the isolate was also labeled as ESBL in the subsequent two cultures done over a month. Interestingly the urine grew the same organism marked as Norflox sensitive even after the patient consumed Norflox for a month.
Will appreciate any microbiological advice on this case.
Opd paper:
INVESTIGATION:
09/08 TO 10/08:
11/08:
17/08:
28/08:
