MRCP2-2714

MRCP2-2714

A 25-year-old man presents to the emergency department with a fever and shortness of breath. He has a past medical history of type 1 diabetes and has had a recent hospital admission with diabetic ketoacidosis. He now has an insulin pump. He does not smoke or drink alcohol.

Observations:
Heart rate 120 beats per minute
Blood pressure 92/48 mmHg
Respiratory rate 22/minute
Oxygen saturations 94% on room air
Temperature 38.4C

On examination, he appears diaphoretic and unwell. Chest auscultation reveals coarse crackles at the right base.

Blood tests:

Hb 138 g/L Male: (135-180)
Female: (115 – 160)
Platelets 189 * 109/L (150 – 400)
WBC 14.7 * 109/L (4.0 – 11.0)
Na+ 138 mmol/L (135 – 145)
K+ 4.2 mmol/L (3.5 – 5.0)
Urea 8.2 mmol/L (2.0 – 7.0)
Creatinine 99 µmol/L (55 – 120)
CRP 221 mg/L (< 5) A chest -ray demonstrates consolidation in the right lower zone. He is commenced on empirical broad-spectrum antibiotics to treat sepsis secondary to pneumonia. At 24 hours, a blood culture grows Klebsiella pneumoniae , which is identified as producing carbapenemase. What is the most appropriate antibiotic choice?