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Author: Frosinski, JJ/ Brunkhorst, FM (2013) Source: Dtsch Med Wochenschr 2013; 138: 1723–1726.

CASE REPORT

Frosinski, JJ/ Brunkhorst, FM (2013)

Peripheral venous catheter-related E. faecalis sepsis with fatal outcome


Background:
Peripheral venous catheters (PVC) are often underestimated as cause of nosocomial infections. Particularly for immunosuppressed and elderly patients, delays in diagnosis and therapy can be fatal. This case report describes a PVC-associated bloodstream infection with fatal outcome.


Case history/diagnostic findings: A 82 year-old man contracted Herpes zoster with meningoencephalitis. He was admitted to a neurological clinic, where he was treated with a virostatic agent (Aciclovir) over a PVC in the right elbow pit. This was an inappropriate site for PVC insertion. Although the patient recovered from the meningoencephalitis during hospital stay, he developed a catheter-associated phlebitis in the right elbow pit. The patient was prescribed an oral cephalosporin and discharged. Three days later, he had to be readmitted after emergency medical treatment due to fever and general discomfort.


Examinations: In the elbow pit, there was a 3 x 3 cm abscess, which was incised. Blood analysis showed increased markers of inflammations, however, microbiological diagnostics was not carried out. As the patient’s condition got worse, transthoracic echocardiography was performed, which identified vegetation on the aortic and mitral valves as well as on the cardiac pacemaker wires.


Diagnosis/therapy/course: Diagnosis revealed an endocarditis triggered by Enterococcus faecalis. Although an ampicillin and vancomycin therapy adjusted to the antibiogram was started, the patient’s condition deteriorated, and he died as a result of the catheter-associated bloodstream infection.


Conclusions: Signs of bloodstream infection – repeated confusion due to fever in this case – should be taken into account in any case. The authors emphasise the major importance of early diagnostic clarification by blood cultures and of targeted antibiotic treatment based on the antibiogram.


Source:
Dtsch Med Wochenschr 2013; 138: 1723–1726.


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