title: A Case of Septic Shock Due to Serratia marcescens Pyelonephritis and Bacteremia in a Patient Receiving Empagliflozin.
abstract: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been associated with serious urinary tract infections (UTIs) including pyelonephritis and urosepsis. The Food and Drug Administration (FDA) issued a label change to include this warning in December 2015 due to a small number of cases (n = 19) reported to the FDA Adverse Event Reporting System. Details of these cases are limited and none involved empagliflozin. To date, there has been no published literature comprehensively describing serious UTIs attributed to empagliflozin. We describe a case of septic shock due to Serratia marcescens pyelonephritis and bacteremia that required intensive care unit admission in a well-controlled, type 2 diabetic patient who had begun taking empagliflozin 2 months prior. The patient was treated successfully with intravenous antibiotics followed by oral ciprofloxacin. After discontinuation of empagliflozin and completion of antibiotic therapy, no subsequent UTIs were documented in the following 4 months.
authors.affiliation: 1 Department of Pharmacy, Upstate University Hospital, Syracuse, NY, USA.
authors.forename: Wesley D
authors.initials: WD
authors.lastname: Kufel
authors.affiliation: 2 University at Buffalo School of Pharmacy and Pharmaceutical Sciences, Buffalo, NY, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Scrimenti
authors.affiliation: 3 Department of Pharmacy, Upstate University Hospital, Syracuse, NY, USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Steele
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D001559:Benzhydryl Compounds / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy; D005960:Glucosides / Q000009:adverse effects*; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D008297:Male; D011704:Pyelonephritis / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D016868:Serratia Infections / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis; D012706:Serratia marcescens / Q000187:drug effects / Q000302:isolation & purification*; D012772:Shock, Septic / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis
chemical_list: D001559:Benzhydryl Compounds; D005960:Glucosides; D007004:Hypoglycemic Agents; C570240:empagliflozin
keywords: empagliflozin; pyelonephritis; sodium–glucose cotransporter 2 inhibitor; urinary tract infection