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Presentation

A patient admitted with community-acquired pneumonia was enrolled in the hospital’s sepsis pathway and treated with ceftriaxone and azithromycin. Despite stepwise escalation to piperacillin–tazobactam and later meropenem plus vancomycin, the patient deteriorated after only a brief partial improvement. The first blood culture was negative, the sputum was inconclusive and the urine culture was negative, creating major diagnostic uncertainty.

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Additional Diagnosis Information
A second blood culture ultimately revealed carbapenem-resistant Klebsiella pneumoniae (CRKP). This case illustrates the limitations of empiric escalation, the value of repeat cultures and the global challenge of managing CRKP in resource-limited hospitals where guideline-preferred agents are unavailable.

Author Information

Sabir Awad Mustafa Mohammedzein, M.D., Consultant Microbiologist, Wadi Aldawasir General Hospital, Saudi Arabia.


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