Septic shock due to Aeromonas hydrophila bacteremia in a patient with alcoholic liver cirrhosis: a case report

Abstract

IntroductionAeromonas hydrophila sometimes causes bacteremia, which can be fatal in compromised patients, such as those with liver cirrhosis. We present a case of septic shock due to Aeromonas hydrophila bacteremia in a patient with liver cirrhosis, which was successfully treated with rapid resuscitation and critical care.Case presentationA 71-year-old Japanese man with liver cirrhosis was transported to our emergency center by ambulance after presenting with gait difficulties and fever. On arrival, he exhibited shock and severe lactic acidosis, which was suggestive of sepsis, and was immediately resuscitated and administered empiric antibiotic therapy. He also displayed catecholamine-resistant hypotension, which was successfully treated with critical care including supportive therapies, such as polymyxin B hemoperfusion and cytokine-absorbing hemofiltration. Aeromonas hydrophila was detected in his initial blood cultures.ConclusionsAeromonas septicemia should be considered in patients with alcoholic liver cirrhosis who have profound shock. In addition to goal-directed therapy and the prompt administration of empiric antibiotic therapy, aggressive critical care involving multiple supportive therapies can save such patients.

Mortality analysis of Aeromonas hydrophila infection in hepato‐biliary pancreatic surgery: Multicenter retrospective observational study

“…Although intensive treatments including veno-arterial extracorporeal membrane oxygenation, T A B L E 2 Mortality analysis of patients with Aeromonas hydrophila isolation polymyxin B hemoperfusion, or cytokine-absorbing hemofiltration have been reported as successful for patients with A hydrophila sepsis, the effect might be limited. 17,18 Our mortality analysis showed that blood loss > 1000 mL might be a risk factor for mortality in patients with A hydrophila infection. However, massive blood loss has long been recognized as a risk factor for SSI.…”

Aeromonas Infections in Patients with Liver Cirrhosis in Japan

“…The clinical characteristics and prognoses of 25 reported cases of Aeromonas infections in patients with LC in Japan reported from 1992 to 2016 are summarized in Table 1. Among the 25 cases, three were reported in English [4,13,14] and the remaining 22 in Japanese [9,11,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The age at diagnosis of Aeromonas infection ranged between 40 and 78 years, and 19 patients were male and five were female with one case unknown.…”

“…The age at diagnosis of Aeromonas infection ranged between 40 and 78 years, and 19 patients were male and five were female with one case unknown. The etiology of LC was as follows: hepatitis C virus (HCV) infection in six cases [13,21,22,25,29], hepatitis B virus infection in six [9,11,16,26,27,30], alcohol-related in nine [4,14,15,17,20,21,23,28,31] HCV infection plus alcoholrelated in one [22], and unknown in three [18,19,24]. The Child-Pugh classification of underlying liver dysfunction was as follows; Child C in nine, Child B in one, and unknown in 15 cases.…”

Bacteremia por Aeromonas caviae en paciente con hepatitis autoinmune: presentación de caso

“…infecciones son causadas por Escherichia coli, Klebsiella spp., Enterobacter spp. y P. aeruginosa 23 . En el reporte presentado, el origen de la sepsis fue una bacteremia descartando previamente los otros focos más frecuentes.…”

“…En pacientes cirróticos, lo anterior se ha relacionado con la presencia de translocación bacteriana por alteración de la barrera intestinal producto del edema, congestión e hipoxia local 26,27 . En el caso presentado, no fue posible identificar heridas, infecciones en piel o trauma previo al inicio del cuadro clínico, por lo que se consideró como fuente más probable de transmisión la vía oral como se ha reportado en otros casos similares 23,27 .…”