This report describes a 79-year-old Caucasian man with a history of syringomyelia, paraplegia and a long-term urethral catheter, presenting with recurrent catheter-related or catheter-associated urinary tract infections (CAUTIs) and persistent delirium. On one occasion, urine cultured bacteria from the Burkholderia cepacia complex (BCC). This organism is recognised as being a coloniser of fluid or aquatic settings. However, in certain circumstances (eg, immunosuppression, immunocompromise, multimorbidity), BCC has been recognised to cause infection, that is, rather than merely contamination or colonisation. In this unwell older patient, treatment of the BCC CAUTI was guided by antibiotic sensitivities and microbiology advice. The report incorporates a brief discussion of some relevant microbiological terminology, and refers to associations and commoner sites of BCC-related infection. The report concludes by exploring how three philosophical concepts (Occam's razor, Hickam's dictum and Crabtree's bludgeon) proved relevant in supporting clinical decision-making in this case.
BMJ case reports. 2019 Nov 14*** epublish ***
Olayinka Ayodele Ogundipe, Rebecca Claire Pearson, Amy Campbell
Department of Medicine of the Elderly, Royal Infirmary of Edinburgh, Edinburgh, UK., Department of Medicine of the Elderly, Borders General Hospital, Melrose, Scotland, UK .