1. Presented by Mark Hopkins, MD and reviewed by Karen Carroll, MD

A middle-aged patient presents to the emergency department with a 7 day history of chills and fever, and recently diagnosed acute kidney injury. The patient had recently returned from a trip to countries in southern Asia. When the symptoms first started, the patient was seen at an urgent care clinic where the patient was told that they have a viral illness, and was referred to primary care doctor. The patient's primary care doctor performed basic lab tests, which demonstrated an elevated creatinine, prompting the patient to present to the emergency department. Upon presentation, the patient was found to be febrile to 39.5 °C. A complete blood count demonstrated an increased white count (18 K/mm3) with a predominance of neutrophils (88%). Blood cultures were drawn, which revealed the following:



 





Antimicrobial Susceptibilities:

Ampicillin	R
Azithromycin	S
Ceftriaxone	R
Ciprofloxacin	R
Meropenem	S
Trimethoprim-Sulfamethoxazole	R

What is the pathogen of most concern?