Dysuria and fever post surgery

A 73 year old man presents to you one week after undergoing successful thyroid surgery. He has a fever(38.7°C), pain on passing urine and frequency. A urine sample was collected and demonstrated 4 + leukocytes and 4+ RBCs. After blood and urine cultures are obtained, you start him on ceftriaxone 1 gram Q24H to be administered in OPAT.

Two days later he is afebrile, and reports some improvement in urinary symptoms.

The laboratory reports a Serratia marcescens isolate [> 10⁵ CFU/mL] with the susceptibility pattern presented below.

Antimicrobial Interpretation
Ampicillin R
Amoxicillin-clavulanate R
Cephalexin R
Cephazolin * R
Imipenem I
Ertapenem S
Gentamicin S
Tobramycin S
Trimethoprim/sulfamethoxazole  R
Ciprofloxacin R
Nitrofurantoin S
Fosfomycin S

 

Would you change the therapy and, if so, to which agent?


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