Localized Multidrug-Resistant Morganella morganii Urinary Tract Infection in a Dapagliflozin-Treated Man with Bladder Outlet Obstruction and Incomplete Ureteral Duplication: A Case Report
Abstract
Background and Clinical Significance: Sodium-glucose cotransporter-2 (SGLT2) inhibitors cause persistent glucosuria, which has been hypothesized to facilitate urinary tract infection (UTI) when urinary stasis or anatomic variants coexist; causality, however, remains unproven and almost certainly multifactorial. Case Presentation: A 72-year-old man treated with dapagliflozin 10 mg/day for 4 months presented with 3 days of dysuria and nocturia, without fever or systemic signs. One month before SGLT2 inhibitor initiation, urological work-up had been unremarkable: prostate ~50 cm3, post-void residual (PVR) 0 mL, and a negative midstream culture. At presentation we obtained a midstream clean-catch specimen before antibiotics. Dipstick showed glucose 2+ (~100 mg/dL, as expected with SGLT2 inhibition), leukocyte esterase 3+ and nitrites negative; microscopy revealed 45 leukocytes/high-power field with pronounced bacteriuria. Quantitative culture grew Morganella morganii at 1 × 105 CFU/mL in pure culture. Antimicrobial susceptibility (VITEK® 2 Compact, EUCAST v14.0, 2024) demonstrated resistance to ampicillin, amoxicillin-clavulanate, ampicillin-sulbactam, ceftriaxone, ceftazidime, gentamicin and trimethoprim-sulfamethoxazole, with susceptibility (S) retained only to piperacillin-tazobactam, levofloxacin/norfloxacin, cefepime and carbapenems (ertapenem, meropenem). Imaging revealed a right duplicated ureter with distal fusion (single bladder insertion, no dilatation or obstruction)…
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