Acute Cholecystitis Presenting With Septic Shock as the First Presentation in an Elderly Patient

Auda, Ahmed; Abdullah, Rashid Al; Khalid, Mohammed O; Alrasheed, Wedyan Y; Alsulaiman, Sumaiyah A; Almulhem, Fai T; Almaideni, Meriam F; Alhikan, Aisha

doi:10.7759/cureus.20981

Cited by 7 publications

(6 citation statements)

References 11 publications

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“…The causes of a partial response to antibiotic therapy consist of three aspects: the antibiotic, the target pathogen, and the patient’s body system. These aspects include the bacterial status, inoculum size, antibiotic concentrations, serum effects, and host-gut microbiome interactions [ 11 ]. However, we ruled out these hypotheses because K. ozaenae was not detected in the later cultures and because the second chest CT revealed that opacity in the lower left lung zone had improved.…”

Section: Discussionmentioning

confidence: 99%

A Case of Complicated Pneumonia Caused by Klebsiella ozaenae

Tachibana¹,

Mouri²,

Sano³

et al. 2022

Cureus

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Klebsiella ozaenae, a subtype of K. pneumonia, causes chronic upper respiratory tract infections, such as rhinitis and rhinoscleroma, and can also cause lethal infections. We report the case of a patient who developed pneumonia caused by K. ozaenae. An 87-year-old man presented to our hospital with fever and chills. Physical examination revealed no findings other than bilateral crackles in the lower lung fields. Chest computed tomography (CT) showed infiltrative shadows in the lower left lung field. Moreover, K. ozaenae was detected in blood cultures. Based on the examination results, including radiography and blood culture, the patient was diagnosed with pneumonia caused by K. ozaenae. On admission, the patient was treated with intravenous ceftriaxone (CTRX), but he did not recover. After determining the antibiotic susceptibility of K. ozaenae, we stopped administering CTRX and started ampicillin/sulbactam (ABPC/SBT) treatment for two weeks. During the ABPC/SBT administration, a second chest CT showed a new infiltrative shadow in the upper left lung field. Despite these findings, the patient was discharged from the hospital as his vital signs were stable and his general condition was good. After two weeks of ABPC/SBT treatment, the patient was switched to minocycline and followed up. Although infections caused by K. ozaenae are rare, they can be life-threatening. K. ozaenae identification in a patient's blood culture indicates a potentially impaired immune system, prompting physicians to evaluate the patient's immune system.

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Section: Discussionmentioning

confidence: 99%

A Case of Complicated Pneumonia Caused by Klebsiella ozaenae

Tachibana¹,

Mouri²,

Sano³

et al. 2022

Cureus

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“…La CA es una de las consecuencias más comunes de colelitiasis, que ocurre principalmente debido a la obstrucción del conducto cístico por cálculos impactados [21,22] . El desarrollo de cambios secundarios en el contexto de la CA, como gangrena, inflamación xantogranulomatosa, hemorragia y enfisema, define la CA grave [21,23] .…”

Section: Discussionunclassified

“…A, Vesícula distendida de 15x8x6cm gangrenada en cuerpo y bacinete, conteniendo en su interior coágulos organizados color rojo oscuro, y múltiples cálculos, el mayor de 15mm. B,C,D y E, Salida de contenido vesicular (coágulos y cálculos) durante la colecistectomía laparoscópica CG [25] ; y el factor de riesgo más prevalente es la diabetes mellitus, la cual se asocia a poli-neuropatía, lo cual puede enmascarar el cuadro [22,25] .…”

Section: Discussionunclassified

Gangrena vesicular por colecistitis hemorrágica en paciente sin factores de riesgo: reporte de un caso

Vera-Portilla

Portilla²,

Sila³

et al. 2022

Acta Med Peru

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La colecistitis hemorrágica es una complicación rara de la colecistitis aguda, pero con alta mortalidad. Clínicamente es idéntica a la colecistitis aguda, y no suele presentarse con hemorragia gastrointestinal. Presentamos el caso de un varón 57 años, sin antecedentes, ni uso de anticoagulantes, referido a nuestro hospital por una “tumoración vesicular”, tras los estudios tomográficos y de colangioresonancia, asociado a la caída de hemoglobina sérica, se define su sospecha. Ingresa a sala de operaciones y se evidencia una vesícula gangrenada, conteniendo coágulos y cálculos. Confirmando su diagnóstico con el estudio histopatológico. Debido a su similitud clínica, debe considerarse en pacientes con antecedentes de terapia anticoagulante, trauma, malignidad, o hallazgos compatibles con colecistitis alitiásica. Pero puede presentarse en pacientes sin antecedentes y estar asociado a colelitiasis. El diagnóstico temprano de esta complicación potencialmente fatal es importante para facilitar el manejo quirúrgico urgente, siendo el apoyo imagenológico, necesario para su sospecha.

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“…The mortality rate of severe biliary infections ranges from 1% to 6%, reaching 10-20% when combined with bacteremia. This is crucial, especially in the elderly, in which bacteremia following the biliary tract infection is the second most frequent cause of sepsis [10,11].…”

Section: Introductionmentioning

confidence: 99%

Updates on Antibiotic Regimens in Acute Cholecystitis

Fico,

La Greca,

Tropeano

et al. 2024

Medicina

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Acute cholecystitis is one of the most common surgical diseases, which may progress from mild to severe cases. When combined with bacteremia, the mortality rate of acute cholecystitis reaches up to 10–20%. The standard of care in patients with acute cholecystitis is early laparoscopic cholecystectomy. Percutaneous cholecystostomy or endoscopic procedures are alternative treatments in selective cases. Nevertheless, antibiotic therapy plays a key role in preventing surgical complications and limiting the systemic inflammatory response, especially in patients with moderate to severe cholecystitis. Patients with acute cholecystitis have a bile bacterial colonization rate of 35–60%. The most frequently isolated microorganisms are Escherichia coli, Klebsiella spp., Streptococcus spp., Enterococcus spp., and Clostridium spp. Early empirical antimicrobial therapy along with source control of infection is the cornerstone for a successful treatment. In these cases, the choice of antibiotic must be made considering some factors (e.g., the severity of the clinical manifestations, the onset of the infection if acquired in hospital or in the community, the penetration of the drug into the bile, and any drug resistance). Furthermore, therapy must be modified based on bile cultures in cases of severe cholecystitis. Antibiotic stewardship is the key to the correct management of bile-related infections. It is necessary to be aware of the appropriate therapeutic scheme and its precise duration. The appropriate use of antibiotic agents is crucial and should be integrated into good clinical practice and standards of care.

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Acute Cholecystitis Presenting With Septic Shock as the First Presentation in an Elderly Patient

Cited by 7 publications

References 11 publications

A Case of Complicated Pneumonia Caused by Klebsiella ozaenae

A Case of Complicated Pneumonia Caused by Klebsiella ozaenae

Gangrena vesicular por colecistitis hemorrágica en paciente sin factores de riesgo: reporte de un caso

Updates on Antibiotic Regimens in Acute Cholecystitis

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