R. Alvarez

68 F presented to ED with 2 days of dysuria, fever, and progressive confusion. On arrival: T 39.1°C, HR 118, BP 86/52, RR 24, lactate 3.4 mmol/L. Altered mental status and suprapubic tenderness. UA: >100 WBC/hpf, positive nitrites, positive leukocyte esterase. Blood cultures ×2 drawn — both subsequently positive for Escherichia coli. Urine culture: E. coli >100,000 CFU/mL. Resuscitated with 30 mL/kg crystalloid; MAP remained <65 mmHg. Norepinephrine initiated and titrated over 18 hours for septic shock. Creatinine rose from documented baseline 0.9 to 2.3 mg/dL with urine output <0.5 mL/kg/hr, consistent with acute kidney injury (KDIGO stage 2). Empiric IV ceftriaxone started, de-escalated to ciprofloxacin per sensitivities. Hospital course: hemodynamics stabilized by day 2, pressors weaned, creatinine returned toward baseline (1.1) by discharge, mental status cleared. Discharged day 6 on oral antibiotics. Assessment: Severe sepsis with septic shock secondary to E. coli urosepsis; acute kidney injury, resolving.