Dhoble Abhijeet, Chung Won
Department of Internal Medicine, Michigan State University, East Lansing, Michigan, USA.
J Clin Med Res. 2009 Jun;1(2):109-14. doi: 10.4021/jocmr2009.04.1238. Epub 2009 Jun 21.
Despite emergence of early goal directed therapy, septic shock still carries a high mortality. Gram negative septicemia is notorious for rapid deterioration due to endotoxin release. Multi-organ damage due to septic shock carries poor prognosis, and such patients should be managed aggressively with multidisciplinary approach. We present a fatal case of a patient with gram negative septicemia who rapidly deteriorated, and died due to acute refractory severe septic shock. This patient probably developed urosepsis secondary to severe urinary tract infection. He also had infiltrates on chest radiograph. He expired within fifteen hours of presenting to the emergency department. This case emphasizes the importance of early recognition and management of septic shock. Early goal directed therapy has shown to improve mortality. Broad spectrum antibiotics should be started within one hour depending on local immunity of organisms. This case also highlights the fact that despite optimized treatment, this entity has very high mortality rates.
Hemodynamic deterioration; Refractory septic shock; Gram negative septicemia.
尽管出现了早期目标导向治疗，但感染性休克的死亡率仍然很高。革兰氏阴性败血症因内毒素释放导致病情迅速恶化而臭名昭著。感染性休克引起的多器官损害预后较差，此类患者应采用多学科方法积极治疗。我们报告一例革兰氏阴性败血症患者的致命病例，该患者病情迅速恶化，因急性难治性严重感染性休克死亡。该患者可能继发于严重尿路感染而发生了尿脓毒症。他的胸部X光片也有浸润影。他在就诊急诊科后15小时内死亡。该病例强调了早期识别和治疗感染性休克的重要性。早期目标导向治疗已显示可降低死亡率。应根据当地微生物的耐药情况在1小时内开始使用广谱抗生素。该病例还突出了一个事实，即尽管进行了优化治疗，但这种疾病的死亡率仍然很高。
血流动力学恶化；难治性感染性休克；革兰氏阴性败血症。
