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ABSTRACT 667

SEVERE SEPSIS CAUSED BY PSEUDOMONAS AERUGINOSA. CASE REPORT

Merisescu, M.1; Jugulete, G.1; Streinu-Cercel, A.2; Florea, D.3; Luminos, M.1

Pediatric Critical Care Medicine: May 2014 - Volume 15 - Issue 4_suppl - p 151
doi: 10.1097/01.pcc.0000449393.64321.58
Abstracts of the 7th World Congress on Pediatric Critical Care
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1Pediatric Intensive Care, National Institute for Infectious Diseases “Prof. Dr. Matei Bals, Bucharest, Romania 2Manager, National Institute for Infectious Diseases “Prof. Dr. Matei Bals, Bucharest, Romania 3Genetic Laboratory, National Institute for Infectious Diseases “Prof. Dr. Matei Bals, Bucharest, Romania

Background and aims: Pseudomonas aeruginosa is a Gram negative bacillus which can cause severe infections especially in immunocompromised patients. Most infections caused by this germ, are nosocomial.

Aims: Severe infection in immunocompetent patients caused by this microbe is extremely rare. Mortality rate in sepsis caused by PS. aeruginosa is very high (up to 60%).

Methods: We present the case of a 2 year old boy admitted in our clinic for fever, diarrhea, impaired general condition, vesiculobullous and petechial exanthema. Shortly after admission the patient presents an episode of acute respiratory failure followed by apnea and he is tracheal intubated and mechanically ventilated.

Results: During admission the general condition remains serious, the patient remains sedated and respiratory assisted. Biological: severe pancytopenia, coagulation disorders, nitrogen retention syndrome, hypoalbuminemia, hepatic cytolysis syndrome, procalcitonin and inflammatory tests intense positive.The cultures of skin lesions were suggestive for Pseudomonas aeruginosa, confirmed after 48 hours by blood culture identification and PCR determination (Plex ID).We established comprehensive treatment: antibiotic, antifungal, inotropic drugs, ENP, human immunoglobulin, blood and blood products transfusions and Neupogen.The evolution was favorable after 24 hours.

Conclusions: Positive diagnosis of severe sepsis was based on clinical and laboratory findings. We have established the likely starting point of the patient severe condition to be the multiple skin lesions and untreated anal fissure. Although the patient was immunocompetent, he developed a severe form of sepsis with septic shock caused by Ps. aeruginosa hardly responsive to treatment. We believe that the patient’s favorable development was due to this germ’s increased sensitivity to antibiotics, most likely community acquired.

©2014The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies