Septic shock caused by Klebsiella oxytoca: An autopsy case and a survival case with driving Extracorporeal Membrane Oxygenation

Abstract

We report two cases of Klebsiella oxytoca bacteremia. Case 1 was a 56-year-old man who was transferred to our hospital by ambulance due to diarrhea and general fatigue. On arrival, he was clearly conscious. However he was in septic shock. We injected broad spectrum antibacterial agents and started intensive care. Though intensive care included continuous hemodiafiltration (CHDF), he died 22 hours after admission. Case 2 was a 69-year-old man with a history of gastrectomy for gastric cancer. He had been admitted to a previous hospital due to ileus. His ileus tube was removed on the eighth day, and he then developed a fever of 38 ºC on the following day. He went into shock and became unconscious; he was therefore transferred to our hospital. We diagnosed septic shock and disseminated intravascular coagulation (DIC). We injected broad spectrum antibacterial agents, and recombinant thrombomodulin alpha (rTM). Although he was started in intensive care, his hemodynamics were unstable on the day following admission. Extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) were started to maintain his hemodynamics. His condition gradually improved, and he was transferred to the previous hospital for rehabilitation on the 28(th) day. ECMO for septic shock in adults is unusual; however ECMO can be introduced even in patients with severe sepsis under careful monitoring. The new anti-DIC agent rTM is useful for safe driving of ECMO in patients with DIC.

Keywords: Klebsiella oxytoca; Sepsis; extracorporeal membrane oxygenation; intensive care; intra-aortic balloon pumping; recombinant thrombomodulin alpha.

Figure 1. Treatment and course from the admission to 8^th day. From the first day, meropenem (3g/day), vancomycin (2g/day), and rTM were started (rTM was finished on the 5^th day). On the second day, he was intubated and mechanical ventilation was started. CHDF, IABP, and ECMO were also started. On both 3^rd and 5^th days, platelet and fresh frozen plasma were infused. On the 4^th day, ECMO was removed. IABP was removed on the 5^th day. On the 8^th day, he was extubated and moved to the general ward