A 66-year-old female patient developed severe Serratia liquefaciens sepsis following vitamin C infusion treatment by a naturopathic practitioner. The clinical course of the infection was characterized by several complications, and the direct costs of the hospital stay amounted to about 40,000 Euro. Genotypically identical S. liquefaciens was isolated from the residue of the infusate given to the patient, as well as from the washbasin overflow and from two other infusion bottles. A careful inspection of the dispensing facilities and review of procedures used to prepare the infusate revealed several indications of poor hygiene. However, the source of contamination could not be fully clarified. This case report raises questions about the local facilities and personal qualifications required for naturopathic practitioners to conduct invasive procedures and demonstrates that lapses in hygiene can lead to severe morbidity and high cost. CASE REPORTA 66-year-old female patient presented with symptoms of septic shock, meningism, and loss of consciousness. Her medical history revealed a carcinoma of the cervix (stage IIIb) successfully treated by primary radiotherapy 3 years previously. The day before, she had received an intravenous infusion containing 200 ml (i.e., 30 g) of vitamin C, 50 ml of lactopurum (homeopathic dilution [D4] of lactic acid in water for injection), and 250 ml of isotonic 0.9% sodium chloride solution via a peripherally inserted venous catheter. Immediately after termination of the infusion, the patient suffered from neck pain, vomiting, and fever. First, she was given symptomatic medication (i.e., antipyretic and antiemetic drugs), but during the night, her state worsened dramatically.On admission to the intensive care unit, the patient was comatose, her skin was pale and cyanotic, and the peripheral pulses were not palpable. Clinically, we found signs of meningism. The leukocyte count was 22.8 ϫ 10 9 /liter, and the level of vitamin C in serum was 55.9 mg/liter (reference value, 5.0 to 15.0 mg/liter). Blood cultures revealed growth of S. liquefaciens that was sensitive to piperacillin plus tazobactam, cotrimoxazole, cefotaxime, ceftriaxone, and gentamicin, but insensitive to ampicillin, cefazolin, cefuroxime, and nitrofurantoin. At the time of admission, piperacillin and tazobactam were given empirically as antibiotic medication. A sample from the remainder of the original infusate was obtained for culture and also revealed growth of S. liquefaciens, as confirmed by API 20E (BioMerieux). The initial antibiotic therapy was conducted until the 11th day after admission, and S. liquefaciens could not be isolated any longer after this initial period.The further clinical course was characterized by a protracted septic shock with disseminated intravascular coagulation (Ddimers Ͼ 20 mg/liter); the clinical picture of systemic inflammatory response syndrome, with a great need for catecholamines to support circulation; adult respiratory distress syndrome; reversible acute renal failure; severe anasarca;, a...
Implementation of the certification was assessed as positive, although it involves additional investments. The application of the approach was considered feasible as compared with other regions. The portion of antibiotic therapy use and partly that of other drugs was comparable to the findings of Wischnewski et al., Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 54(11):1147-1152, 2011. Re-assessing the indication for urinary tract catheters might have a positive influence on the prevention of infections. The certification can trigger the exchange of information on MRP and antibiotic stewardship between nursing home physicians.
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