M Fill, J Stephens
M Fill, J Stephens. Abdominal Abscess and Septic Shock Secondary to Yokenella regensburgei. The Internet Journal of Infectious Diseases. 2009 Volume 9 Number 1.
A 77-year-old male underwent esophagogastrectomy for esophageal adenocarcinoma. Pertinent medical history included atrial fibrillation, renal cancer, coronary artery disease, diabetes mellitus, gastroesophageal reflux disease, hypertension, dyslipidemia, and osteoarthritis. There was a remote history of tobacco use, but no alcohol use.
Post-operatively, the patient had to be reintubated for aspiration. The patient subsequently deteriorated and became septic. Cultures grew gram-negative rods from three sites: abdominal fluid via aspiration, blood (one of two) and sputum. CT scan revealed minimal air in the right posterior lung base, scattered free fluid in the abdomen and fluid adjacent to the left lobe of the liver consistent with abscess. Computerized laboratory identification (Microscan Walkaway Model 76SI, manufactured by Siemens) identified the gram-negative rods as
Pertinent labs included a red blood cell count of 3.38 mil/cm2, hemoglobin of 9.8 gm/dl, hematocrit of 29.4%, and platelet count of 119 K/cm2. White blood cell count was initially 15.6 K/cm2, peaked at 19.4 K/cm2 and eventually stabilized to 10.7 K/cm2.
The patient was placed on piperacillin/tazobactam (MIC < 16), levofloxacin (MIC <2), linezolid, fluconazole and metronidazole. His hospital course was complicated by respiratory failure requiring tracheostomy, percutaneous drainage of the abdominal abscess and eventual transfer to a rehabilitation center. There was no evidence of anastamotic leak.
One of the interesting aspects of this case concerns where and how this patient could have contracted