chronic prostatitis due to streptococcus codes

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. This strain was resistant to all of Eliava Institutes standard phage preparations. Copyright 2021 Johri, Johri, Hoyle, Pipia, Nadareishvili and Nizharadze. FAQ 3: What ICD-10-CM code should I report for chronic prostatitis? Nonbacterial prostatitis: If the prostatitis is nonbacterial, the prostate may be inflamed but uninfected. Int. Phage-Antibiotic Synergy Is Driven by a Unique Combination of Antibacterial Mechanism of Action and Stoichiometry. M21.42 12. (2018). Cloudy urine. 176 (1), 119124. Phages in Nature. The subtypes are classified by their varied laboratory analysis, clinical presentation and response to treatment. Bacterial infections cause some but not all cases of prostatitis. Radiography is typically unnecessary. Bacteriophage 1 (1), 3145. N41.1. They may void more frequently or with greater urgency. Most patients can be treated as outpatients with oral antibiotics and supportive measures. Agents 31 (1), 8590. ICD-10-CM Code. Mayrier A, et al. Patient information: A handout on this topic is available at https://familydoctor.org/familydoctor/en/diseases-conditions/prostatitis.html. The institute scientists established a clinic, the Eliava Phage Therapy Center (EPTC), to specialize in bacteriophage therapy in 2011. MeSH Opin. Prostatitis (adult). Microbiol. Your practice probably sees multiple patients for prostate-related pain. No calculus was observed. Prostatic massage should be avoided in patients suspected of having acute bacterial prostatitis. Table 1 shows the outcomes of these tests. Dont miss: If the chronic prostatitis is bacterial, you should use an additional code from categories B95- through B97- to identify the infectious agent, if known. TABLE A1. AJ, PJ, and NH have written the case report. Author disclosure: No relevant financial affiliations. Institute of Medical Sciences, Banaras Hindu University, India, Mehr Chand Mahajan DAV College for Women Chandigarh, India, Department for Cardiovascular and Thoracic Surgery, German Heart Center Berlin, Germany, Mazandaran University of Medical Sciences, Iran. Bacteriophage therapy is proposed as a promising alternative treatment of CBP and related infections. Meyrier A, et al. Patients with bacterial prostatitis may also experience flu-like symptoms. Lytic phages propagate by injecting their DNA into the bacterial cell, disrupting bacterial metabolism and replicating inside the cell. Microbiol. Recurrent prostate infection What are the treatment options. Presence of leukocytes along with positive cultures of the EPS or post-prostatic massage urine samples are considered necessary for a positive diagnosis of CBP. The patients EPS and semen were tested again in May 2018. The https:// ensures that you are connecting to the Assoc. mBio 11 (4), e0146220. doi:10.1128/AAC.01281-19, Kutter, E. M., Kuhl, S. J., and Abedon, S. T. (2015). Search Dates: November 19, 2014, and October 20, 2015. This infection may start when bacteria in the patients urine leaks into their prostate. They have been shown to achieve minimum inhibitory concentration (MIC) in the prostatic secretion (Charalabopoulos, et al., 2003). All rights reserved. If there is concern for obstructed voiding, postvoid residual urine volumes should be measured using ultrasonography. Su, Z. T., Zenilman, J. M., Sfanos, K. S., and Herati, A. S. (2020). 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). privacy practices. J. Antimicrob. Chronic prostatitis is prostate inflammation that lasts for at least three months. Urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern. The testicular and back pains increased initially after starting treatment and began to subside after 3weeks of starting phage therapy. Antimicrob. https://www.uptodate.com/contents/search. CBP is diagnosed by the presence of symptoms, examination of the prostate, and lab tests to determine the bacterial nature of the condition. Significant improvements in symptoms and re-testing of samples after bacteriophage treatment indicated a reduction in the bacterial load and resolution of the infection. Creative Commons Attribution License (CC BY). They can include: (1) Urinary symptoms like urethral burning, difficulty starting a stream, urgency or increased frequency, nocturia, dribbling, and incomplete voiding of bladder; (2) Pain in the perineum, suprapubic region, lower back, abdomen, penis, testicles, groin, and rectum, and pain during ejaculation and dysuria; and. (2019). Pharm. Phages have numerous advantages in the treatment of chronic bacterial infections such as CBP. N28.89. If we combine this information with your protected Accessed Nov. 10, 2021. A prostate infection may come back because antibiotics weren't able to get deep enough into the prostate tissue to destroy all of the bacteria. What's the code for bulimia nervosa? Tabular code (s): Essential (primary) hypertension Includes: high blood pressure hypertension (arterial) (benign) (essential) (malignant) (primary) (systemic) I10 A patient with the chief complaint of headache of three days' duration and frequent urination. Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes. Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a common and non-lethal urological condition with painful symptoms. (2017). He is now symptom free and has restoration of normal activity. Agents 29 (5), 549556. Sharp, V. J., Takacs, E. B., and Powell, C. R. (2010). Some urologists may also recommend lifestyle changes like weight loss and diet changes to alleviate the pain from prostatitis. If the patient has problems with urinating, your urologist may use a catheter to drain their bladder. Acute versus chronic prostatitis: Common strains of bacteria often cause acute bacterial prostatitis. Patients with bacterial prostatitis may also experience flu-like symptoms. Treatment of bacterial infections with phages was explored across the world before the advent of antibiotics. Urology 51 (4), 578584. The risk of nosocomial bacterial prostatitis can be reduced by using antibiotics, such as ciprofloxacin, before transrectal prostate biopsy. Agents 30 (2), 118128. https://www.uptodate.com/contents/search. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota. 2016;29:86. Since 1968, the standard diagnostic test to detect pathogens causing CBP is the Meares-Stamey 4-glass test (Magri, et al., 2009). A 2014 study of patients with acute bacterial prostatitis identified age older than 65 years, body temperature greater than 100.4F (38C), benign prostatic hypertrophy, urinary retention, and transurethral catheterization as factors associated with poor outcomes.23 These outcomes included septic shock, positive blood culture, and prostatic abscess.23 In patients with any of these factors, the physician should strongly consider ordering a complete blood count and a basic metabolic panel. doi:10.1001/jama.282.3.236, Kuipers, S., Ruth, M. M., Mientjes, M., de Svaux, R. G. L., and van Ingen, J. Antibiotic resistance is a growing problem across the world, as bacteria rapidly evolve to develop resistance to antibiotics currently in use globally. Prostatic abscesses occur in 2.7% of patients with acute bacterial prostatitis and require urology consultation for drainage.6 Risk factors for prostatic abscess include long-term urinary catheterization, recent urethral manipulation, and an immunocompromised state. Phage Therapy as an Alternative or Complementary Strategy to Prevent and Control Biofilm-Related Infections. Phages are extremely specific, infecting and killing only their particular strains of bacteria. Or it's possible that the original antibiotic wasn't effective against the specific bacterium causing the infection. Symptoms of CBP are usually prolonged. 8 (981), 17. doi:10.1111/bju.13101, Rhode, C., Resch, G., Pirnay, J.-P., Blasdel, B. G., Debarbieux, L., Gelman, D., et al. September 26)Bacteriophages for Treating Urinary Tract Infections in Patients Undergoing Transurethral Resection of the Prostate: a Randomized, Placebo-Controlled, Double-Blind Clinical Trial. 10 (5), 685688. A few countries have allowed therapeutic use of phages in a regulated manner. LN has overseen the process of writing of the case report and provided technical details where required. 2015 1802. Patients with acute bacterial prostatitis often present with acute onset of irritative (e.g., dysuria, urinary frequency, urinary urgency) or obstructive (e.g., hesitancy, incomplete voiding, straining to urinate, weak stream) voiding symptoms. Treatment with antibiotics often leads to quick relief. Learn Different Types of Prostatitis Additional risk factors for chronic prostatitis/chronic pelvic pain syndrome may include: Complications of acute or chronic prostatitis can include: Complications of chronic prostatitis/chronic pelvic pain syndrome may include: There's no direct evidence that prostatitis can lead to prostate cancer. A convincing history and physical examination are typically sufficient to diagnose acute bacterial prostatitis. https://www.uptodate.com/contents/search. J. Gen. Intern. The site is secure. Med. 39, 4856. 1.6 Chronic Bacterial Prostatitis In November 2016, the patient traveled to Tbilisi, Georgia, to explore phage therapy at the EPTC as a potential treatment for his condition. At the clinic, a full urologic workup was performed. Copyright 2023 American Academy of Family Physicians. The other bacteria were treated with Intesti and Fersis phage preparations from March till June 2017. A recurring prostate infection is usually treated with antibiotics. FAQ 2: What ICD-10-CM code should I report for acute prostatitis? Partin AW, et al., eds. doi:10.3389/fmicb.2017.00981, PubMed Abstract | CrossRef Full Text | Google Scholar. Am. Prostatitis (inflammation of prostate), chronic ICD-10-CM Diagnosis Code J20.0 [convert to ICD-9-CM] Acute bronchitis due to Mycoplasma pneumoniae Acute mycoplasmal bronchitis ICD-10-CM Diagnosis Code N30.01 [convert to ICD-9-CM] Acute cystitis with hematuria Acute hemorrhagic cystitis; Hematuria due to acute cystitis Accessed May 13, 2019. He had no history of urological problems before this diagnosis. Keywords: phage therapy, chronic bacterial prostatitis, bacteriophages, antibiotic resistance, biofilm, case report, Citation: Johri AV, Johri P, Hoyle N, Pipia L, Nadareishvili L and Nizharadze D (2021) Case Report: Chronic Bacterial Prostatitis Treated With Phage Therapy After Multiple Failed Antibiotic Treatments. Microbiol. Phage therapy is one of the key alternatives to antibiotics suggested in the ONeill review (ONeill, 2016). doi:10.1111/j.1574-695x.2010.00723.x, Lipsky, B. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. Front. Ther. PMC Koskella, B., and Meaden, S. (2013). Pinpoint Common Prostatitis Symptoms Many cases of CBP are complicated by infections caused by both nosocomial and community acquired multidrug resistant bacteria. Prostatitis is a disorder of the prostate gland usually associated with inflammation. When a patient has prostatitis, which means their prostate is swollen, tender, and inflamed, you must check the medical documentation for specific details. Viruses 10 (4), 178. doi:10.3390/v10040178, Roberts, R. O., Lieber, M. M., Rhodes, T., Girman, C. J., Bostwick, D. G., and Jacobsen, S. J. Efficacy of Repeated Cycles of Combination Therapy for the Eradication of Infecting Organisms in Chronic Bacterial Prostatitis. Accessed Nov. 9, 2021. In addition, recent studies show that along with bactericidal action, phages also have immune modulating effects, primarily anti-inflammatory effects with chronic inflammatory conditions like CBP; phage therapy holds the potential to provide infection control as well as inflammation reduction. In contrast with antibiotics, phages are bactericidal, have a narrow host range, are self-replicating, adapt to bacterial resistance, penetrate biofilms, and have minimal side effects even with long term usage, as is typically required for antibacterial therapy in chronic bacterial infections (Carlton, 1999; Loc-Carrillo and Abedon, 2011; Pires, et al., 2017; Hoyle and Kutter, 2021). Gill BC, et al. Answer: The patients prostatitis treatment will depend on their symptoms, lab tests, and what the urologist found during their office visit. The Magistral Phage. S. epidermidis was considered non-pathogenic due to its low growth and low virulence. After the first 2weeks, a long-term daily dose of 10ml each of Pyo and Intesti oral phages was established for the next 2months. Code range M00-M02 reports infectious arthropathies due to infections that are direct or indirect True The two types of indirect infections are reactive and postinfective arthropathy True The categories in Chapter 11, Diseases of the Digestive System, begin when food enters the mouth and continue to when it leaves the body through the anus True This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). 2009 ICD-9-CM Diagnosis Code 601.9 Prostatitis unspecified Short description: PROSTATITIS NOS. for acute prostatitis. Inflammation of the prostate. Chronic prostatitis can have symptoms related to urinary tract infections (UTIs), as well as pain in the area of the pelvis or with sexual activity, and other symptoms. Microbiol. Urine testing before and after prostatic massage (also known as the Meares-Stamey 2-glass or 4-glass test) is useful in diagnosing chronic prostate and pelvic disorders; however, such testing should not be performed in patients with suspected acute bacterial prostatitis because prostatic massage increases the risk of bacteremia, and subsequently, sepsis. Careers. doi:10.1080/00365590600748247. Pathogenesis 142, 104048. doi:10.1016/j.micpath.2020.104048, Hanlon, G. W. (2007). Microbiol. This site needs JavaScript to work properly. (2021). FAQ 2: What ICD-10-CM code should I report for acute prostatitis? Roughly 190 million years ago, the extremely successful aculeate hymenopteran lineage of stinging ants, wasps, and bees arose when female ovipositors and sexual accessory glands were co-opted by natural selection to create a unique venom delivery system; the sting (1-4).This system is used by tens of thousands of extant insect species . Phage Therapy: Progress in Pharmacokinetics. Rectal suppositories of Pyo, Intesti, and Staphylococcal bacteriophages were used in rotation for 10days each, with breaks of 10days between different phage suppositories. Nerve damage in the lower urinary tract, caused by surgery or trauma, can cause nonbacterial prostatitis. Elsevier; 2021. https://www.clinicalkey.com. Hospitalization and broad-spectrum intravenous antibiotics should be considered in patients who are systemically ill, unable to voluntarily urinate, unable to tolerate oral intake, or have risk factors for antibiotic resistance. Standard phages have the advantage of being polyvalent cocktail preparations, making it more difficult for bacteria to develop resistance to them, as opposed to the customised monophage preparations which are adapted to the target bacteria through serial passage. Pyo, Intesti, and Staphylococcal phage preparations were used for his treatment. Editors L. H. Green, and E. Goldman 4th edition (Boca Raton, FL: CRC Press). If the acute prostatitis is bacterial, you should report the appropriate code from B95-(Streptococcus, staphylococcus, and enterococcus as the cause of diseases classified elsewhere) through B97- (Viral agents as the cause of diseases classified elsewhere) to identify the infectious agent, if known. Before When a bacterial pathogen becomes resistant to the standard phage preparations, or if there is an infection caused by bacteria other than the ones targeted by the standard phage preparations, a customised monophage preparation against the patients strain can be prepared. Med. Int. Langston ME, et al. Acute urinary retention occurs in approximately one in 10 patients with acute bacterial prostatitis. This reduces future probability of development of conditions caused by chronic inflammation, such as cancer (Grski, et al., 2018). Subjective symptoms of weakness, night sweating, and chills also decreased gradually. 60 (2), 99112. Bacterial prostatitis. The preparations were administered in three formsoral liquid, rectal suppositories, and urethral instillations. Methods and Outcome: Bacteriophage preparations from the Eliava Institute were used to treat the patient after establishing phage sensitivity to the pathogenic bacteria. Urinary Tract Infections and Bacterial Prostatitis in Men. Symptoms can come on quickly and include fever, chills, urinary changes, ejaculatory pain and pain in the pelvis or nearby zones. Approximately 13% of patients with acute bacterial prostatitis experience recurrence necessitating a longer course of antibiotics.6 Patients with persistent or recurrent symptoms should have a repeat urine culture to evaluate for repeat bacterial prostatitis and be treated based on culture results. (2015). Diagnosis is predominantly made based on history and physical examination, but may be aided by urinalysis. Continuing targeted research would allow more countries to adopt this treatment methodology for infection control. Inflammatory markers, such as C-reactive protein and erythrocyte sedimentation rate, will likely be elevated, but these tests have minimal clinical or diagnostic utility.23, Prostate-specific antigen (PSA) levels are not indicated in the workup of acute bacterial prostatitis.11,12,20 Approximately 70% of men will have a spurious PSA elevation due to disruption of prostatic architecture caused by inflammation.19 Elevated PSA levels can persist for one to two months after treatment.11,12 If PSA levels remain elevated for more than two months, prostate cancer should be considered because 20% of persistent elevations are associated with malignancy.19. They may include: Several conditions can contribute to the signs and symptoms associated with prostatitis. 17, 90. doi:10.1186/s12894-017-0283-6, Leitner, L., Ujmajuridze, A., Chanishvili, N., Goderdzishvili, M., Chkonia, I., Rigvava, S., et al. To provide you with the most relevant and helpful information, and understand which Since, patients with antibiotic resistant infections have traveled to Tbilisi for treatment from nearly 70 countries worldwide. 2019; doi:10.1158/1055-9965.EPI-19-0387. NH, LP, LN and DN are paid employees of the Eliava Phage Therapy Center. International Journal of Molecular Sciences. Accessed Nov. 12, 2021. Prostatitis is one of the diagnoses that can cause pelvic pain - not the other way around. Answer: Symptoms of prostatitis include pain in the penis, testicles, groin, perineum, or over the bladder. Click here for an email preview. Authors Rong-Hai Li , Qi Li , Xiao-Hong Shang , Qing-Yong Wang PMID: 30549978 DOI: 10.7754/Clin.Lab.2018.180602 No abstract available Publication types Case Reports MeSH terms Adult This content does not have an English version. The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Air Force Medical Department or the U.S. Air Force at large. Microb. Patients may also have cloudy urine or blood in the urine. J. Urol. Additional laboratory studies can be obtained based on risk factors and severity of illness. Arch. Infect. Current Opinion in Infectious Diseases. The patient experienced no improvement in symptoms during or after these antibiotic courses. from Medscape: Available at: https://emedicine.medscape.com/article/458391-treatment#d9. Management of Chronic Bacterial Prostatitis. Mayo Clinic offers appointments in Arizona, Florida and Minnesota and at Mayo Clinic Health System locations. It is found in the 2023 version of the ICD-10 Clinical Modification (CM) and can be used in all HIPAA-covered transactions from Oct 01, 2022 - Sep 30, 2023 . Pharmacology. 9 (1), 3439. Int. No antipyretic was taken to reduce body temperature. Patients present with a variety . The treatment also depends upon the type of prostatitis the patient has. The patient underwent multiple courses of antibiotic treatment without any long-term resolution of his symptoms. Get immediate care if you have any of the following: There is a problem with doi:10.1126/science.284.5418.1318, de la Fuente-Nez, C., Reffuveille, F., Fernndez, L., and Hancock, R. E. (2013). Phage-Antibiotic Synergy (PAS): -Lactam and Quinolone Antibiotics Stimulate Virulent Phage Growth. Drinking more water and eating more fresh foods and less sugar may also help. doi:10.1038/aja.2009.5, Mah, T.-F. C., and O'Toole, G. A. National Institute of Diabetes and Digestive and Kidney Diseases. Additionally, prostatic calcifications may accompany some CBP cases and are linked with biofilm formation and biofilm-producing bacteria (Mazzoli, 2010). Chronic prostatitis 2016 2017 2018 2019 2020 2021 2022 2023 Billable/Specific Code Adult Dx (15-124 years) Male Dx N41.1 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes. doi:10.4161/bact.1.1.14942, Comeau, A. M., Ttart, F., Trojet, S. N., Prre, M.-F., and Krisch, H. M. (2007). In order to claim this was a case of antibiotic failure, administration of more than one cycle of antibiotic therapy following international guidelines of dosage and timing would have excluded responsiveness of the patient to standard treatment (Magri, et al., 2007; Lipsky, et al., 2010; Kraemer, et al., 2019). Also, anti-inflammatory drugs may reduce the patients pain from the inflammation in the prostate or muscles. Chronic Bacterial Prostatitis Treatment & Management. (2006). 8600 Rockville Pike Federal government websites often end in .gov or .mil. Your practice probably sees multiple patients for prostate-related pain. Advertising revenue supports our not-for-profit mission. Prostate biopsy should not be performed to avoid inducing septicemia. This content does not have an Arabic version. The .gov means its official. When using code N41.1 in processing claims, check the following: See additional coding . Men who have difficulty or pain when urinating are often helped by biofeedback and physical therapy. Fever, chills, muscle aches and other flu-like symptoms (with acute bacterial prostatitis) Background: Chronic Bacterial Prostatitis (CBP) is an inflammatory condition caused by a persistent bacterial infection of the prostate gland and its surrounding areas in the male pelvic region. FAQ 1: What are the different specific types of prostatitis? There are generally four types of prostatitis: Signs and symptoms of prostatitis can vary depending on the type of disorder. Acute bacterial prostatitis is an infection of the prostate due to bacteria. official website and that any information you provide is encrypted The authors thank the Eliava Foundation, Diagnosis 90, Mzia Kutateladze, Nana Balarjashvili, Davit Sturua and the staff at the Eliava Phage Therapy Center for their cooperation and support. A custom phage (autophage) was prepared in September 2017 that was fully sensitive against the S. mitis isolated from the patients sample. AVJ and PJ are joint owners of Vitalis Phage Therapy. They may void more frequently or with greater urgency. See permissionsforcopyrightquestions and/or permission requests. April 05)Expert Opinion on Three Phage Therapy Related Topics: Bacterial Phage Resistance, Phage Training and Prophages in Bacterial Production Strains. Sci. Front. When your urologist performs an orchiectomy, you will need [], If the prostatitis is bacterial, report an additional code from B95- B97. Answer: Symptoms of prostatitis include pain in the penis, testicles, groin, perineum, or over the bladder. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. https://www.uptodate.com/contents/search. Front. CBP is known to significantly impair the quality of life of the sufferer. The quality of life of the patient improved drastically. Krieger, J. N., Lee, S. W. H., Jeon, J., Cheah, P. Y., Liong, M. L., and Riley, D. E. (2008). When a patient has prostatitis, which means their prostate is swollen, tender, and inflamed, you must check the medical documentation for specific details. This was administered according to the previous protocol, along with Staphylococcal bacteriophage, from November 2017 till January 2018, during which time his only remaining symptoms of pelvic and perineum pain decreased in intensity and frequency. in Tackling Drug Resistant Infections Globally: Final Report and Recommendations (London, United Kingdom: Review: UK Department of Health, Review on Antimicrobial Resistance). Most drugs in these classes of antibiotics have high lipid solubility and favourable diffusion values through the lipid membrane of the prostatic epithelium. Bethesda, MD 20894, Web Policies Chronic prostatitis (N41.1) N41.0 N41.1 N41.2 ICD-10-CM Code for Chronic prostatitis N41.1 ICD-10 code N41.1 for Chronic prostatitis is a medical classification as listed by WHO under the range - Diseases of the genitourinary system . Single dose of ceftriaxone (Rocephin), 250 mg intramuscularly, Doxycycline, 100 mg orally twice daily for 10 days, Ciprofloxacin, 500 mg orally twice daily for 10 to 14 days, Trimethoprim/sulfamethoxazole, 160/800 mg orally twice daily for 10 to 14 days, Extend treatment for 2 weeks if patient remains symptomatic, Levofloxacin (Levaquin), 500 to 750 mg orally daily for 10 to 14 days, Continue treatment until patient is afebrile, then transition to oral regimen (group B) for an additional 2 to 4 weeks, Levofloxacin, 500 to 750 mg IV every 24 hours, Piperacillin/tazobactam (Zosyn), 3.375 g IV every 6 hours, Piperacillin/tazobactam, 3.375 g IV every 6 hours, Cefotaxime (Claforan), 2 g IV every 4 hours, Ertapenem (Invanz), 1 g IV every 24 hours, Ceftazidime (Fortaz), 2 g IV every 8 hours, Imipenem/cilastatin (Primaxin), 500 mg IV every 6 hours, Meropenem (Merrem IV), 500 mg IV every 8 hours, Carbapenems can be used if patient is unstable, If patient is stable, follow primary regimen while awaiting culture results, Imipenem/cilastatin, 500 mg IV every 6 hours.

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