An 80-year-old female with a history of diabetes and chronic constipation presents to the emergency room with a purple urine bag. She is currently bedridden and uses an indwelling catheter. On examination, she is hypotensive and confused. Blood cultures are positive for Proteus vulgaris. Based on this patient’s presentation, which of the following antibiotics should be commenced? A. Nitrofurantoin B. Ciprofloxacin C. Ceftriaxone D. Piperacillin - tazobactam

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Purple discoloration of a urinary catheter bag is rare and can be alarming to both patients and healthcare workers. This phenomenon is known as the purple urine bag syndrome. It is associated with urinary tract infections occurring in catheterized patients, generally elderly females with significant comorbidities and constipation. The urine is usually alkaline. Gram-negative bacteria that produce sulfatase and phosphatase are involved in the formation of pigment, indirubin and indigo. Tryptophan metabolism is involved in the pathogenesis. We present two cases of this rare and intere

It can be called as" Purple urine bag syndrome" which is rare and is associated with urinary tract infection. The discoloration is due to the presence of indirubin and indigo within the urine. It typically occurs in elderly females with constipation and significant comorbid conditions.

It is better to put the patient on Piperacillin + Tazobactum, before that, a urine specimen should be collected ( Catherize urine, maintaining SOP ) and send for R /E , M / E and C / S. To evaluate the organism and resitogram, to find out the cause of septicaemia. If it is proteus vulgaris, in alkaline urine Nitrofurantoin is contraindicated.

Ciprofloxacin is also contraindicated as Ciprofloxacin crystals precipitate in alkaline urine and provoke renal failure.
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Ideally selection should be based on c/ s reports.For empirical therapy piperacillin and tazobactam will be more appropriate.As this organisms produces Beta lactamase and tazobactam is inhibitors of this enzyme.

P mirabilis is likely to be sensitive to ampicillin; broad-spectrum penicillins (eg, ticarcillin, piperacillin); first-, second-, and third-generation cephalosporins; imipenem; and aztreonam

Piperacillin +tazobactum

Purple urine bag syndrome. D is the best drug combination to tackle with gram negative bacteria

Proteus vulgaris is gram negative bacteria. Urine culture and sensitivity tobe done. Meanwhile Piperacillin-tazobactum should be given

D. piperacillin .tazobactum

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