Multiple drugs

Abstract

Multiple drugsLack of efficacy: case report A 28-year-old woman exhibited lack of efficacy during treatment with ceftazidime for Escherichia coli vaginal infection. She also exhibited lack of efficacy during treatment with immune-globulin, meropenem, plasma and noradrenaline for shock secondary to Escherichia coli vaginal infection [not all routes and dosages stated].The woman was referred to the ICU at a hospital in China on 15 October 2017. On 11 October 2017, she had received a water-sac induced labour. After 2 days, she experienced continuous vaginal bleeding, hyperpyrexia and chills. Subsequently, she was initiated on ceftazidime 2g, every 8 hours; however, she still progressed to shock. She underwent emergency surgery for foetus elimination and placenta removal. During surgery, she had sustained a vaginal injury and she had gradually fallen in coma. She had also developed shin cyanosis. After admission to ICU during current presentation, she received fluid resuscitation and transfusion with fresh frozen plasma, suspended RBCs and platelets. She was commenced on IV meropenem 1g over 3 hours at every 8 hours, IV immune-globulin injection [human immunoglobulin IV injection], high dose norepinephrine [noradrenaline] 3.0 µg/kg/min, continuous venous-venous haemopurification and ventilator-assisted ventilation. However, she showed no signs of improvement. Therefore, an acute hysterectomy was carried out on 16 October 2017. Gradually, her symptoms were alleviated. Cyclical stability was maintained with norepinephrine 1.0 µg/kg/min. On day 3 of admission, presence of E.Coli was detected. Elevation of WBC was indicative of leukemoid reaction; therefore, treatment with meropenem was continued. Apart from leukemoid reaction, she developed thrombocytopenia. The occurrence of thrombocytopenia was attributed to sepsis. Her clinical condition was improved and she was continued on meropenem. The leukemoid reaction and thrombocytopenia were improved. However, after 2 days, she developed upper GI haemorrhage. On 2 November 2017, she was discharged from hospital.