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ESBL urosepsis — SCE Acute Medicine MCQ

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HardInfectious diseasesESBL urosepsisSCE Acute Medicine

A 72-year-old woman with long-term catheter has fever and flank pain. She is hypotensive and has lactate 4.8 mmol/L. Blood cultures grow ESBL-producing E. coli resistant to ceftriaxone but sensitive to meropenem and gentamicin. She has AKI with eGFR 24 mL/min/1.73m2. What is the most appropriate next step in antimicrobial management?

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Correct answer: E — Escalate to renal-adjusted IV carbapenem with infection specialist input

ESBL bacteraemic urosepsis with shock requires active IV therapy, and a carbapenem is commonly appropriate when sensitivities support it. Dosing should be adjusted for renal function and reviewed with microbiology or infection specialists. Nitrofurantoin is not suitable for pyelonephritis or bloodstream infection.

Reference: NICE NG253; UKHSA Antimicrobial Prescribing Guidance