A Rare Colonization in Peritoneum After Blunt Abdominal Trauma: S. putrefaciens and S. cerevisiae (original) (raw)
Related papers
JR Army Med. Corps, 1988
A case of multiple injuries including blunt rupture of the stomach is reported. It demonstrates that Candida needs to be considered as a possible cause of continued sepsis following a ruptured viscus in the presence of multiple trauma. Surgical drainage is required in this situation, in the same way that abscesses caused by more conventional : organisms require aggressive surgical treatment.
Surgical Infections, 2020
Background: Fungal infections are associated with increased morbidity and death. Few studies have examined risk factors associated with post-operative fungal intra-abdominal infections (FIAIs) in trauma patients after exploratory laparotomy. In this study, we evaluated potential risk factors for acquiring post-operative FIAIs and their impact on clinical outcomes. Methods: This was a retrospective analysis of trauma patients admitted from 2005 to 2018 who underwent exploratory laparotomy and subsequently had development of intra-abdominal infection (IAI). Demographics, comorbidities, culture data, antimicrobial usage, Injury Severity Scores (ISS), and clinical outcomes were abstracted. All post-operative IAIs were evaluated and stratified as either bacterial, fungal, combined, and with or without colonization. All groups were compared. Risk factors for the development of post-operative IAI and clinical outcomes were analyzed by Student t test and chi-square test. Multi-variable logistic regression was used to determine independent predictors of post-operative FIAIs. Results: There were 1675 patients identified as having undergone exploratory laparotomy in the setting of traumatic injury, 161 of whom were suspected of having IAI. A total of 105 (6.2%) patients had a diagnosis of IAI. Of these patients, 40 (38%) received a diagnosis of FIAI. The most common fungal pathogens were unspeciated yeast (48.3%), followed by Candida albicans (42.7%), C. glabrata (4.5%), C. dubliniensis (2.25%), and C. tropicalis (2.25%). There were no significant differences in demographics, comorbidities, and percentage of gastric perforations between FIAI and bacterial IAI (BIAI) groups. Patients with FIAIs, however, had a 75% temporary abdominal closure (TAC) rate compared with 51% in BIAIs (p = 0.01). The FIAI group had higher ISS (27 vs. 22, p = 0.03), longer hospital days (34 vs. 25, p = 0.02), and longer intensive care unit (ICU) days (17 vs. 9, p = 0.006) when compared with BIAI. The FIAI group also had a five-fold greater mortality rate. Logistic regression identified TAC as an independent risk factor for the development of post-operative FIAIs (odds ratio [OR] 6.16, confidence interval [CI] 1.14-28.0, p = 0.02). Conclusions: An FIAI after exploratory laparotomy was associated with greater morbidity and death. A TAC was associated independently with increased risk of FIAI after exploratory laparotomy in the setting of traumatic injury. Clinicians should suspect fungal infections in trauma patients in whom post-operative IAI develops after undergoing exploratory laparotomy using TAC techniques.
Candida Perinephric Abscess: A Rare Presentation in a Trauma Patient
Surgical Infections Case Reports, 2017
Background: The perinephric space is a closed anatomic space that plays an important role in limiting and transmitting disease processes. Perinephric abscess is an uncommon complication of peritonitis. The development of a perinephric abscess caused by Candida is also rare. In this case report we describe an unusual case of perinephric abscess caused by Candida in a trauma patient. To the best of our knowledge, this is the first case described, and as such, represents a novel case. Case Presentation: A 17-year-old male was impaled by a tree branch in a go-cart accident and presented to the emergency department with small bowel evisceration through the abdominal wall defect in his left upper quadrant. After he was assessed, he was taken to the operating room for emergency abdominal exploration. Surgical exploration revealed a large gastric laceration with diffuse peritonitis and massive contamination of the peritoneal cavity by gastric contents and minor trauma to the inferior pole of the spleen adjacent to the left kidney. After gastric repair, abdominal lavage, and staged abdominal wall reconstruction, the patient was treated with antibiotics for peritonitis. During the post-operative recovery period the patient became febrile with increasing white blood cell (WBC) count. Abdominal contrast-enhanced computed tomography (CT) revealed fluid accumulation in the left perinephric space, which was drained percutaneously and grew Candida albicans. Conclusion: Candida can cause perinephric abscess in patients with peritonitis and the clinical picture is usually indistinguishable from that caused by bacteria. A better understanding of the patient's risk factors and events as in this case, would presumably result in earlier diagnosis and prompt management.
The American Surgeon, 2015
Invasive candidiasis is associated with worse outcomes and increased mortality in critically ill patients. The Candida score (CS) provides a clinical tool for identifying patients at risk for invasive candidiasis. Outcomes of severely injured trauma patients with positive Candida cultures stratified by their CS have not been well described. In this retrospective observational study, all severely injured trauma patients (Injury Severity Score ≥16) admitted to the Los Angeles County and University of Southern California Medical Center from April 2008 to April 2014 with positive Candida cultures were included. Outcomes of patients with a low risk for invasive candidiasis (CS < 3) were compared with those with a high risk (CS ≥ 3). A CS ≥ 3 was significantly associated with higher mortality (35.9% vs 5.0%, P = 0.001), longer length of stay (LOS) (median 49.0 vs 28.0, P = 0.002), longer intensive care unit LOS (35.0 vs 20.0, P < 0.001), requirement for renal replacement therapy (38...
Clinical Significance of Candida Isolated from Peritoneum in Surgical Patients
The Lancet, 1989
Over a 2-year period, all surgical patients from whom Candida was isolated from intra-abdominal specimens were evaluated. All but 1 of the 49 evaluable patients had either a spontaneous perforation (57%) or a surgical opening of the gastrointestinal tract (41%). Candida caused infection in 19 patients (39%), of whom 7 had an intra-abdominal abscess and 12 peritonitis. In the other 30 patients (61%), there were no signs of infection and specific surgical or medical treatment was not required. Candida was more likely to cause infection when isolated in patients having surgery for acute pancreatitis than in those with either gastrointestinal perforations or other surgical conditions. The development of a clinical infection was significantly associated with a high initial or increasing amount of Candida in the semiquantitative culture. Surgery alone failed in 16 of 19 patients (84%), of whom 7 died and 9 recovered after combined antifungal and surgical treatment. The overall mortality and the mortality related to infections were significantly higher in the patients with intraabdominal candidal infections than in those without such infections.
Infection, 2009
Background: Different micro-organisms can be cultured from abdominal fluid obtained from patients with intra-abdominal infection resulting from a perforated digestive tract. We evaluated a cohort of patients with abdominal sepsis admitted to the intensive care with the aim of obtaining more insight into the type of microorganisms involved and the efficacy of treatment. Materials and Methods: A 5-year prospective observational cohort study was performed in patients admitted to the intensive care unit with abdominal sepsis syndrome, defined as a perforation of the digestive tract and inflammatory response with organ failure. Abdominal fluid was obtained for microbial culture during the surgical procedures and from abdominal drains. The initial treatment protocol was cefotaxim, ciprofloxacin, metronidazole, and amphotericin B, tailored according to microbiological results. Selective decontamination of the digestive tract was administered to prevent secondary endogenous infections. Results: Abdominal fluid was taken for microbial culture from 221 of the 239 patients admitted with abdominal sepsis. Aerobic Gram-negative bacteria (AGNB) were found in 52.9% of the cultures of abdominal fluid taken at the time of operation, of which 45% were Escherichia coli; in 36% of patients more than one AGNB was found. The incidence of AGNB was highest in colorectal perforations (68.6%) and perforated appendicitis (77.8%) and lowest in gastroduodenal perforations (20.5%). Gram-positive bacteria were found in 42.5% of the abdominal fluid cultures and most frequently in colorectal perforations (50.0%). Candida was found in 19.9% of patients, with 59.1% of these cultures being Candida albicans. The incidence of Candida was 41.0% in gastroduodenal perforations and 11.8% in colorectal perforation. Anaerobic bacteria were cultured in 77.8% of patients with perforated appendicitis. Over time, the prevalence of AGNB in abdominal fluid decreased from 117 patients (52.9%) in the first culture to one patient (6.7%) in week 4 (efficacy 87%). The prevalence of Grampositive bacteria increased from 42.5% to 86.7% in a 4-week period. Conclusion: The composition of the intra-abdominal flora found in critically ill patients with abdominal sepsis varies depending on the location of the perforation. The efficacy of combined surgical and antibiotic treatment was 87% in 4 weeks for AGNB.
Journal of Medical Microbiology, 2010
There is a need to understand the epidemiology and risk factors associated with candidaemia in critically ill trauma patients. The rise in incidence of non-albicans candidaemia and the emergence of antifungal resistance have made such a study necessary. A prospective laboratory-based surveillance study was performed over a period of 21 months (April 2008-December 2009) at a level I trauma centre in New Delhi, India. All blood culture samples positive for Candida were processed for microbial identification by standard methods. Identification was carried out by conventional methods, using chromogenic medium (CHROMagar Candida) and by the automated Vitek 2 system. These isolates were characterized for their susceptibility to amphotericin B, fluconazole, flucytosine and voriconazole. Eighty-nine episodes of candidaemia occurred in 89 patients during the study period. The incidence was 0.71 episodes per 1000 patient days. A total of 136 Candida isolates were obtained, with non-albicans Candida species accounting for over 80 %. Candida rugosa, a rarely isolated pathogen, accounted for 25 (18.4 %) of the isolates, and 5.9 % of the isolates were resistant to fluconazole. None of the isolates showed resistance against amphotericin B, flucytosine or voriconazole. The present study revealed that non-albicans Candida species caused most of the cases of candidaemia in the trauma patients. The isolation of C. rugosa from a large number of cases highlights the ability of this rarely reported pathogen to cause bloodstream infections. The presence of azole resistance among many of the Candida isolates is a matter of concern. Major risk factors for candidaemia include intravascular catheters, dialysis, burns, immunosuppression, use of steroids, diabetes, multiple abdominal surgeries, parenteral hyperalimentation and use of broad-spectrum antibiotics (Krcmery & Babela, 2002). The clinical presentations of patients with sepsis caused by C. albicans and non-albicans Candida species are indistinguishable. However, nonalbicans Candida species are often less susceptible to fluconazole than C. albicans and may require a greater dosage of antifungals to cure clinically (Gó mez et al., 2009).
Journal of Medical Case Reports, 2017
Background: In critically ill patients with colonization/infection of multidrug-resistant organisms, source control surgery is one of the major determinants of clinical success. In more complex cases, the use of different tools for sepsis management may allow survival until complete source control. Case presentation: A 42-year-old white man presented with traumatic hemorrhagic shock. Unstable pelvic fractures led to emergency stabilization surgery. Fever ensued with diarrhea, followed by septic shock. Two weeks later, an abdominal computed tomography scan revealed suprapubic and ischiatic abscesses at surgical sites, as well as dilated bowel. Debridement of both surgical sites, performed with vacuum-assisted closure therapy, yielded isolates of carbapenem and colistin-resistant Klebsiella pneumoniae. Antibiotic treatment was de-escalated after 21 days; 4 days later fever, leukocytosis, hypotension and acute renal failure relapsed. Blood purification techniques were started, for the removal of endotoxin and inflammatory mediators, with sequential hemodialysis. Clinical improvement ensued; blood cultures yielded Candida albicans and multidrug-resistant Acinetobacter baumannii; panresistant carbapenemase-producing Klebsiella pneumoniae grew from wound swabs. In spite of shock reversal, our patient remained febrile, with diarrhea. Control blood cultures yielded Candida albicans, Acinetobacter baumannii and carbapenem-resistant Klebsiella pneumoniae. His abdominal pain increased, paralleled by a right flank palpable mass. Colonoscopy revealed patchy serpiginous ulcers. At exploratory laparotomy, an inflammatory post-traumatic pseudotumor of his right colon was removed. Blood cultures turned negative after surgery. Septic shock, however, relapsed 4 days later. A blood purification cycle was repeated and combination antimicrobial therapy continued. Surgical wounds and blood cultures were persistently positive for carbapenem-resistant Klebsiella pneumoniae. Removal of pelvic synthesis media was therefore anticipated. Three weeks later, clinical, microbiological, and biochemical evidence of infection resolved. Conclusions: High quality intensive assistance for sepsis episodes needs a clear plan of cure, aimed to complete infection source control, in a complex multidisciplinary interplay of specialists and intensive care physicians.
Isolated jejunal perforation from nonpenetrating abdominal trauma
The American Journal of Emergency Medicine, 1993
Although jejunal perforation from blunt trauma is a common injury, isolated jejunal perforation is an uncommon entity. A case of isolated jejunai perforation from blunt trauma is presented. This case showed that symptoms and physical findings from jejunai perforation may be minimal. The use of various diagnostic procedures, such as chest radiograph for free air, diagnostic peritoneal iavage, or abdominal computed tomography for diagnosing intestinal perforation were reviewed. Serial abdominal examination continued to be paramount in diagnosing intestinal injuries. Sufficient vigilance and suspicions of small bowel perforation should always be considered after blunt trauma even when symptoms and physical findings are minimal. (Am J Emerg Med 1993;11:473-475. Copyright 0 1993 by W.E. Saunders Company) CASE REPORT A 36-year-old black male was referred to our emergency department from a prison facility "to exclude a submental abscess." The patient was an unrestrained driver involved in a head-on motor vehicle collision 2 days previous, but he did not remember the accident well. He was arrested at the scene because of suspected ethanol intoxication and did not receive any medical evaluation despite his having suffered facial abrasions. The patient complained of pain and some discharge in his facial wound and continued diffuse abdominal discomfort for 2 days. He did not have any nausea, vomiting, fever, or chills. He had eaten without any problems for the last 2 days. The last meal he ingested was only 1 hour before his arrival to the emergency department. The patient's medical history consisted of hypertension only. He did not have any previous surgery. His medications included a "water pill" and another antihypertensive agent that he can not remember. There were no allergies. and the date of his last tetanus vaccine was unknown. His temperature was 36.9"C: pulse rate was 84 beats/mini and respirations were 16 breaths/min. Blood pressure was 140/90 mm Hg. The patient was a normal built male without any evidence of distress on presentation. His examination was remarkable for a 3-cm healing laceration on the chin with minimal erythema, and a 1 S-cm laceration on the inner mucosa that remained open. No evidence of any infections in the wound was noted. The lungs were clear, and the heart was normal. The abdomen was soft, but had minimal discomfort with palpation diffusely, even with deep palpation. There was no rebound tenderness, no mass noted. and the bowel sounds were normal. The rectal examination was normal, without any occult blood present in the stool. The wound was irrigated without any further treatment. The inner mucosal laceration was left to be healed by secondary intention. Tetanus prophylaxis was given. The laboratory findings showed a