14/04/25 (Batch B), 16/04/25 (Batch C), 17/04/25 (Batch A)
A 75-year-old man is admitted to the ICU with acute myocardial infarction. He is
unconscious and put on Foley’s catheter and central venous line. Three days later he
develops fever and hypotension.
Blood
Nutrient agar
Shape: round
Size: 2-4 mm
Colour: whitish
Surface: smooth
Elevation: convex
Edges: entire
Opacity: opaque
Emulsifiability: easily emulsifiable
Observation: Violet coloured spherical shaped
bacteria in clusters
Inference: Gram positive cocci seen
Catalase: Positive
Slide coagulase: Negative
Tube coagulase: Negative
Coagulase negative Staphylococcus spp.
Mannitol fermentation: Not Fermented
Beta haemolysis on blood agar: Negative
Heat-stable nuclease: Negative
CRBSI
04.12.24 A 49-year-old man with no Initial laboratory study Clinical features, history of
medical history presented to results were notable for a water logging and laboratory
hospital for a history of fever, creatinine of 2.3 mg/dL, results are suggestive of
myalgias, and severe bilateral platelets of 58,000 cells/mm3, fulminant leptospirosis also
calf pain that began six days hemoglobin of 12.8 G/dL, known as Weil’s disease.
prior. He denied recent travel and white blood cell count of 8.9 ×
worked as a construction worker. 103 cells/mm3 with
He complains of requent lymphopenia of 2.4%, total
episodes of water logging at the bilirubin of 4.3 mg/dL, direct
construction site. Vital signs in bilirubin of 2.6 mg/dL, alkaline
the emergency department were phosphatase (ALP) of 143 U/L,
notable for a temperature of aspartate aminotransferase
101°F, pulse of 120 beats/min (AST) of 201 U/L, alanine
and blood pressure of 156/63 mm aminotransferase (ALT) of 246
Hg. The patient was alert and U/L, and creatine kinase of
oriented. The ocular examination 1219 U/L. The urine analysis
was notable for scleral icterus. showed moderate hematuria
The skin appeared jaundiced, the but no proteinuria. Serological
lungs were clear to auscultation, studies show reactive for
the abdomen was soft, bilateral Leptospira IgM antibody
lower extremity tenderness was
noted and dorsal pedal pulses
were present bilaterally.
18/03/2025 A seriously ill 60-year-old Both the blood culture Clinical presentation is suggestive
elderly patient was admitted to bottles flagged positive and of catheter related bloodstream
the ICU of our health setup 5 identification was done infection (CRBSI)
days ago. A non-tunneled CVC using Vitek-2 identification
was in place in the femoral vessel system and identified as
4 days back. The patient is Pseudomonas aeruginosa
having severe fever and chills on both the specimen.
since yesterday. His CBC is
raised and he is having high CRP
value. The catheter was removed
and a section of catheter tip was
sent to the microbiology lab
along with a peripheral blood
culture in Bact-Alert automated
Blood culture bottle.growth of
catheter tip flashed positive 2.5
hours prior to the peripheral
blood culture bottle.
18/03/2025 Mrs. Akshita Mehta, 65-year-old 2 sets of blood culture were Clinical presentation is suggestive
female, was admitted CCU after drawn from central line and of central line -associated
having a heart-attack on peripheral line (mid cubital bloodstream infection (CLABSI)
03.08.2022. The next day, a vein) respectively. Both of caused by E. coli
central line was inserted in the them flagged positive and
cath-lab. On day 4 of her were identified as E. coli.
admission, she developed a fever
(102°F).
