Yu Alexander Tin Han, Cun Tony, Benamu Esther, Renault Cybele
Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
Department of Medicine, Stanford University, Stanford, California, USA.
BMJ Case Rep. 2017 Nov 8;2017:bcr-2017-220656. doi: 10.1136/bcr-2017-220656.
bacteraemia (SAB) remains a complex disease with a high associated morbidity and mortality, especially when it is able to establish an occult nidus safe from antimicrobial eradication. Without rapid identification and intervention, the nidus can cause persistent relapse of disease, morbidity and mortality. Having a high clinical suspicion for the foci of occult is important, and awareness of potential sites of infection is critical and can be life-saving.We present a unique case of a 65-year-old man with end-stage renal disease receiving haemodialysis who developed septic shock from SAB. Despite 18 days of appropriate antibiotics, the patient had persistent high-grade bacteraemia until his gall bladder was ultimately percutaneously drained. The day after drainage, he cleared his blood cultures, although he ultimately passed away as he decided to transition his care to focus on comfort measures.
血流感染(SAB)仍然是一种复杂的疾病,具有较高的相关发病率和死亡率,尤其是当它能够形成一个免受抗菌药物根除的隐匿病灶时。如果没有快速识别和干预,该病灶可导致疾病持续复发、发病和死亡。对隐匿病灶的部位保持高度临床怀疑很重要,了解潜在的感染部位至关重要,甚至可能挽救生命。我们报告一例独特病例,一名65岁终末期肾病接受血液透析的男性因SAB发生感染性休克。尽管使用了18天合适的抗生素,患者仍持续存在高度血流感染,直到最终经皮引流其胆囊。引流后的第二天,他的血培养转阴,不过他最终还是决定将治疗重点转向舒适护理措施,随后去世。