Abstract
BackgroundCatheter-related blood stream infection (CRBSI) is one of the most common intractable healthcare-associated infections because catheters can be easily contaminated by resistant bacteria, and is associated with a high mortality. Central lines are currently used for administering medication to patients with severe stroke, and may thus cause CRBSI.Case presentationA 71-year-old woman with cirrhosis presented with subarachnoid hemorrhage (SAH) that was treated by clipping surgery. On postoperative day (POD) 38, sudden high fever (40.3 °C) was detected; the patient died a few hours later. Blood and central line cultures were positive for Klebsiella pneumoniae that may have caused CRBSI and endotoxin shock. In this case, the duration from fever detection to death was notably short. Additionally, inflammatory markers such as white blood cells (WBC) or C-reactive protein (CRP) were almost within normal ranges, even a few hours after fever was detected and before death. Cirrhosis was considered to be the cause of these phenomena.ConclusionThe timely diagnosis and complete treatment of patients with liver cirrhosis who develop CRBSI are highly challenging. We suggest that clinicians should rigorously apply preventive measures and strengthen CRBSI monitoring, especially in cirrhosis-associated cases.
Highlights
Catheter-related blood stream infection (CRBSI) is one of the most common intractable healthcareassociated infections because catheters can be contaminated by resistant bacteria, and is associated with a high mortality
We suggest that clinicians should rigorously apply preventive measures and strengthen CRBSI monitoring, especially in cirrhosis-associated cases
The subarachnoid hemorrhage (SAH) was believed to be caused by a right middle cerebral artery (MCA) aneurysm that was classified as World Federation of Neurosurgical Societies Grading of SAH (WFNS) Grade II and computed tomography (CT) Fisher Group III
Summary
CRBSI patients with liver cirrhosis are very challenging to treat. Funding No funding was obtained for this study. All authors read and approved the final manuscript. Ethics approval and consent to participate This case report involves a patient. The case report complies with the Helsinki Declaration, and approval was obtained from the ethics committee of Saiseikai Yokohamashi Tobu Hospital. Consent for publication Written informed consent for the publication of this case report and any accompanying images was obtained from the younger sister and daughter of the patient. Author details 1Department of Neurosurgery, Saiseikai Yokohamashi Tobu hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-8765, Japan. Author details 1Department of Neurosurgery, Saiseikai Yokohamashi Tobu hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama, Kanagawa 230-8765, Japan. 2Department of Endovascular Surgery, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Kanagawa 230-8765, Japan. 3Department of Physiology, Keio University School of Medicine, Tokyo 160-8582, Japan. 4Department of Clinical Research, Tochigi Medical Center, National Hospital Organization, Utsunomiya, Tochigi 320-8580, Japan
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