Carbapenem-resistant Bacteremia and Metastatic Abscesses – A Community-acquired Infection of Concern

Systemic dissemination of uropathogens from the genitourinary tract resulting in the formation of psoas and chest wall abscesses represents a rare yet significant complication of urinary tract infections (UTIs). This phenomenon is widespread in high-risk individuals like those with poorly controlled diabetes mellitus, and if left untreated, can lead to severe, potentially fatal outcomes. The community is increasingly concerned about the infections caused by multidrug-resistant pathogens. Here, a man in his 50s with uncontrolled type 2 diabetes (HbA1c = 16.6%) presented with fever, chills, rigours, and right flank pain worsening with hip extension, occasionally radiating to the groin. He developed a painful swelling on the right upper chest with erythema. Diagnostic workup revealed metastatic infection by a carbapenem-resistant Escherichia coli, which began as bilateral pyelonephritis and progressed to bacteremia, psoas abscess, and thoracic wall abscess. All abscesses were resolved with amikacin treatment, which led to a favourable outcome. This case highlights the atypical presentations of carbapenem-resistant Escherichia coli pyelonephritis as well as the diagnostic challenge of atypical Carbapenem-resistant Enterobacterales [CRE] infections in high-risk diabetic patients, emphasising the need for blood and pus cultures to identify multi-drug resistant (MDR) pathogens and guide effective treatment, and prevent antimicrobial resistance (AMR), alongside community education and individualised care for prevention and early intervention.