Raoultella planticola Bacteremia-Induced Fatal Septic Shock and Sepsis-Induced Coagulopathy in a Patient with Pancreatic Cancer: A Case Report and Literature Review

K. Hajiyeva, M. Oral
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Abstract

Background: Raoultella planticola is a gram-negative rod-shaped bacterium commonly found in water and soil and considered to be a rare and possibly underestimated cause of severe human infection. Its presence should be suspected in older patients with a history of cancer, immune suppression and recent exposure to traumatic injuries or invasive medical procedures. Case presentation: A 78-year-old male with a history of hypertension was diagnosed with pancreatic adenocarcinoma. Whipple procedure (pancreaticoduodenectomy) was performed afterwards. On the 8th day of surgery, the patient was admitted to our tertiary ICU with septic shock. His initial Sequential Organ Failure Assessment (SOFA) score was 12 with predicted mortality 95.7%. Empirical antibiotic therapy with colymicin, meropenem and teikoplanin was administered immediately and two sets of blood cultures were obtained. Patient developed refractory septic shock despite the addition of vasopressin and the patient’s condition continued to deteriorate. Patient died on the third day of sepsis. His blood culture was positive for R. planticola, which was identified using the VITEK-2 biochemical identification system. Conclusions: Clinicians should be aware of fatal unusual infections in immunocompromised patients.
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1例胰腺癌患者因planticola Raoultella菌血症致致致死性败血性休克及败血症致凝血功能障碍:1例报告及文献复习
背景:planticola Raoultella是一种革兰氏阴性杆状细菌,常见于水和土壤中,被认为是一种罕见的,可能被低估的人类严重感染的原因。在有癌症史、免疫抑制和近期暴露于创伤性损伤或侵入性医疗程序的老年患者中,应怀疑其存在。病例介绍:一位78岁男性,有高血压病史,被诊断为胰腺腺癌。术后行胰十二指肠切除术(Whipple)。手术第8天,患者因感染性休克入住我院三级ICU。他最初的序贯器官衰竭评估(SOFA)评分为12分,预测死亡率为95.7%。立即给予经验性抗生素治疗,包括colymicin、meropennan和teikoplanin,并进行两组血培养。尽管加用抗利尿激素,患者仍发生难治性脓毒性休克,病情持续恶化。病人死于败血症的第三天。经VITEK-2生化鉴定系统鉴定,血培养结果为车前菌阳性。结论:临床医生应注意免疫功能低下患者的致命异常感染。
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