Vecchio Marc J, Jankowich Matthew, Qadir Hassan, Gaitanis Melissa, Menon Anupama
Brown University Warren Alpert Medical School, Eddy St, Providence, RI 02903, USA.
Department of Pulmonary and Critical Care Medicine, Providence Veteran Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA.
Case Rep Infect Dis. 2020 Dec 5;2020:8812635. doi: 10.1155/2020/8812635. eCollection 2020.
bacteremia in immunocompetent patients is rare with very few reported cases in the literature. We present a case of bacteremia in an 81-year-old immunocompetent man with small bowel obstruction and hypoxemia during the COVID-19 pandemic. Routine monitoring of prognostic inflammatory markers for COVID-19 created a unique challenge in the management of our patient who developed sepsis with respiratory symptoms. Upon review, bacteremia from was associated with high mortality rates and could produce similar elevations in the inflammatory markers observed in COVID-19 pneumonia. Further, we reviewed the cognitive biases encountered when monitoring these inflammatory markers during the management of our patient with bacteremia, who was initially thought to have COVID-19 disease. While our patient ultimately tested negative for COVID-19, early administration of empiric antimicrobial therapy without source control failed to prevent clinical decompensation.
免疫功能正常的患者发生菌血症的情况很少见,文献中报道的病例极少。我们报告了一例81岁免疫功能正常的男性在新冠疫情期间发生菌血症,同时伴有小肠梗阻和低氧血症。对新冠患者的预后炎症标志物进行常规监测,给我们这位出现败血症并伴有呼吸道症状的患者的治疗带来了独特的挑战。经审查,菌血症的死亡率很高,并且可能导致在新冠肺炎中观察到的炎症标志物出现类似升高。此外,我们回顾了在管理这位最初被认为患有新冠疾病的菌血症患者时,监测这些炎症标志物时遇到的认知偏差。虽然我们的患者最终新冠检测呈阴性,但在未进行源头控制的情况下早期给予经验性抗菌治疗未能预防临床失代偿。