A man in his 80s with a history of mild cognitive impairment and benign prostatic hypertrophy presented to our hospital in septic shock, presumed secondary to pyelonephritis. His medical history included nonvalvular atrial fibrillation, for which he took warfarin. He was initially febrile (temperature, 38.4°C), tachycardic (pulse rate, 111/minute), and hypotensive (systolic blood pressure <90 mm Hg). His international normalized ratio was 3.37, so warfarin was held. He was initially resuscitated with intravenous fluids and prescribed piperacillin-tazobactam empirically.
Al-Abri M, Wong BM, Leis JA. A Urinary Catheter Left in Place for Slightly Too LongA Teachable Moment. JAMA Intern Med. 2015;175(2):163. doi:10.1001/jamainternmed.2014.6583