A case of sepsis caused by ceftriaxon resistant shigella flexneri

Shigella spp. primer olarak kalın bağırsağı enfekte eder. Şigelloz tüm dünyada ishal vakalarının %10- 20’sini oluşturmaktadır. Çocuklarda Shigella enfeksi- yonları en sık 1-4 yaşlarında görülür. Üç buçuk aylık erkek hasta, 10 gün önce başlayan, ateş ve kanlı ishal yakınmalarıyla başvurdu. Hasta bu yakınmalarla baş- vurduğu diğer bir sağlık kuruluşunda 9 gün süreyle yatırılarak intravenöz seftriakson ile tedavi edilmiş ancak yakınmaları geçmemişti. Hastanın fizik muaye- nesinde; genel durumu kötü ve malnütre görünümde idi. Dehidratasyonu olan hastada rektal prolapsus saptandı. Hasta sepsis, ishal, ağır dehidratasyon, mal- nütrisyon ve rektal prolapsus olarak değerlendirildi. PT, PTT uzun ve D-dimer düzeyi yüksek olan hastada dissemine intravasküler koagülasyon (DİK) geliştiği saptandı. Hastaya uygun sıvı tedavisi ile birlikte, intra- venöz K vitamini verildi, taze donmuş plazma desteği yapıldı. Kan kültüründe seftriakson dirençli Shigella flexneri ürediği öğrenilen hastaya meropenem tedavisi başlandı. Takibinde hastanın rektal prolapsusu ve ishali düzeldi ve hasta şifa ile taburcu edildi. Şigellozun seyri sırasında bakteriyemi, sepsis, DİK gibi kompli- kasyonlar özellikle küçük yaş ve malnutrisyon gibi risk faktörlerinin varlığında gelişebilmektedir. Tedavi plan- lanırken, Shigella spp.'nin neden olduğu ağır gastroen- teritin ampirik antibiyotik tedavisinde sıklıkla kullanılan seftriaksona karşı direnç olabileceği akılda bulundurul- malıdır.

Seftriakson dirençli shigella flexneri’nin neden olduğu sepsis olgusu

Shigella spp. mainly infect the large intestine. Worldwide, 10-20% of diarrheal disease is due to Shigella spp. Shigellosis is most commonly seen at 1-4 years of age in children. A three and a half month old male patient presented with fever and bloody diarrhea often days duration. He was hospitalised in another hospital for these symtoms and treated with intravenous ceftriaxon for 9 days. Phsical examina- tion revealed poor general condition, malnutrion and dehydratation. Other systemic examinations were normal except for rectal prolapse. He was diagnosed with diarrhea, severe dehydratation, sepsis and rectal prolapse. Laboratory exaninations revealed pro- longed PT and aPTT and elevated level of D-dimer. Disseminated intravascular coagulation (DIC) was diagnosed on the basis of these laboratory findings. He was given appropriate fluid therapy and intrave- nous vitamin K. Fresh frozen plasma replacement was performed. Blood culture yielded ceftriaxon resistant Shigella flexneri and meropenem treatment was commenced. He was successfully treated. This case illustrates that complications such as bactere- mia, sepsis, DIC can develop during the course of Shigellosis, especially in the presence of risk factors such as malnutrition and young age. Ceftriaxone is frequently used in empirical antibiotic treatment of severe Shigella spp. gastroenteritis. This report emphasizes that ceftriaxone resistance should be taken into consideration in Shigella spp. infections.

Kaynakça

1. Giannella RA. Infectious Enteritis and Proctocolitis and Bacterial Food Poisoning. In: Feldman M, Friedman LS, Brandt LJ (eds), Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 9th ed. Saunders, Philadelphia; 2010. p. 1843-87. [CrossRef]

2. DuPont HL. Shigella Species (Bacillary Dysentery). In: Mandell GL, Bennett JE, Dolin R (eds), Mandell, Douglas and Bennett's Principles and Practice of Infectious Diseases. 7th ed. Churchill Livingstone, Philadelphia; 2009. p. 2958-73.

3. Niyogi SK. Increasing antimicrobial resistance-an emerging problem in the treatment of shigellosis. Clin Microbiol Infect 2007; 13: 1141–3. [CrossRef]

4. Sur D, Ramamurthy T, Deen J, Bhattacharya SK. Shigellosis: chal- lenges & management issues. Indian J Med Res 2004; 120: 454-62.

5. Mandell W, Neu H. Shigella Bacteriemia in Adults. JAMA 1986; 255: 3116-7. [CrossRef]

6. Anatoliotaki M, Galanakis E, Tsekoura T, Schinaki A, Stefanaki S, Tsilimigaki A. Urinary Tract Infection Caused by Shigella sonnei. Scand J Infect Dis 2003; 35: 431-3. [CrossRef]

7. Twum-Danso K, Marwah S, Ahlberg A.Shigella osteomyelitis in a fit young man. Trop Geogr Med 1993; 45: 88-9.

8. Drow DL, Mercer L, Peacock JB. Splenic abscess caused by Shigella flexneri and Bacteroides fragilis. J Clin Microbiol 1984; 19: 79-80.

9. Gupta A, Polyak CS, Bishop RD, Sobel J, Mintz ED. Laboratory- confirmed Shigellosis in the United States, 1989-2002: Epidemiological trends and patterns. Clin Infect Dis 2004; 38: 1372-7. [CrossRef]

10. Greenberg D, Marcu S, Melamed R, Lifshitz M. Shigella bactere- mia: A retrospective study. Clin Pediatr 2003; 42: 411-5. [CrossRef]

11. Goldenstein B, Giroir B, Randolph A; Members of the International Concensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005; 6: 2-8. [CrossRef]

12. Özmert EN, İnce OT, Örün E, Yalçın S, Yurdakök K, Gür D. Clinical characteristics and antibiotic resistance of Shigella gast- roenteritis in Ankara, Turkey between 2003 and 2009, and com- parison with previous reports. Int J Infect Dis 2011; 15: 849-53. [CrossRef]

13. http://ecdc.europa.eu/en/publications/Publications/1111_ SUR_Annual_Epidemiological_Report_on_Communicable_ Diseases_in_Europe.pdf. (Erişim tarihi 6 Ekim 2012)

14. Ashkenazi S, Cleary TG. Shigella Species. In: Long SS, Pickering LK, Prober CG (eds), Principles and Practice of Pediatric Infectious Diseases. 3rd ed. Churchill Livingstone, Philadelphia; 2009. p. 817-20.

15. Shiferaw B, Solghan S, Palmer A, et al. Antimicrobial Susceptibility Patterns of Shigella Isolates in Foodborne Diseases Active Surveillance Network (FoodNet) Sites, 2000- 2010. Clin Infect Dis 2012; 54: 458-63. [CrossRef]

16. Taneja N, Mewara A, Kumar A, Verma G, Sharma M. Cephalosporin-resistant Shigella flexneri over 9 years (2001-09) in India. J Antimicrob Chemother 2012; 67: 1347-53. [CrossRef]

17. Bhattacharya D, Sugunan AP, Bhattacharjee H et al. Antimicrobial resistance in Shigella - rapid increase & widening of spectrum in Andaman Islands, India. Indian J Med Res 2012; 135: 365-70.

18. Altun B, Gür D. Antimicrobial resistance profiles of Shigella spp. isolated from feces samples in Hacettepe University Ihsan Dogramaci Children's Hospital between 1999-2010. Mikrobiyol Bul 2011; 45: 609-16.

19. Karacan C, Tavil B, Topal Y, Zorlu P, Tayman C. Evaluation of shigellosis in a Turkish children's hospital. Pediatr Int 2007; 49: 589-92. [CrossRef]

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