#idboardreview 80 M BPH presents w/ fever, dysuria, hematuria. CT:hydroureteronephrosis. UA +LE. Urine/blood culture anaerobic Gram+rod R to FQ/tmp-smx. Dx? #medEd #idmedEd #IDtwitter ImageImage
Ddx fastidious, anaerobic GPR; Propionibacterium spp. (skin flora) & Actinobaculum schaalii. Clostridium: spore-forming anaerobic GPR or gram variable some grow aerobically. Eubacterium: fecal flora but gram-Peptostreptococcus & Micromonas micros are fastidious anaerobic cocci
#actinotignum schaalii cause infection particularly in the elderly or patients with abnormalities of the urinary tract
#Actinotignum schaalii should be considered in differential of UTI when urine analysis reveals significant pyuria and negative nitrite testing, and especially in cases with a negative aerobic culture & anaerobic GPR R to ciprofloxacin & tmp-smx.
S to b lactam & vancomycin

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