meropenem and Emergencies

We describe 3 previously healthy Costa Rican children who had Listeria monocytogenes meningitis, an uncommon cause of bacterial meningitis beyond the newborn period in normal subjects. Two of them had initial normal brain computed tomography, but all 3 developed acute hydrocephalus at days 7, 3, and 5, respectively. All required immediate ventriculostomy placement and only 1 of 3 survived. L. monocytogenes should be considered among the etiologies of bacterial meningitis in children who do not respond initially to conventional antimicrobial treatment or who deteriorate rapidly.

Topics: Acute Disease; Amikacin; Cefotaxime; Child; Child, Preschool; Combined Modality Therapy; Costa Rica; Dexamethasone; Drug Resistance; Drug Therapy, Combination; Emergencies; Fatal Outcome; Female; Humans; Hydrocephalus; Male; Meningitis, Listeria; Meropenem; Rifampin; Thienamycins; Tomography, X-Ray Computed; Vancomycin; Ventriculostomy

A 27-year-old woman was admitted to the emergency department with fever and a petechial rash on suspicion of meningitis. Shortly after arriving she developed cardiac arrest. Blood work up showed severe lactate acidosis, anaemia and thrombocytopenia. A focused assessment with sonography in trauma scan showed free intraperitoneal fluid and an emergency laparotomy revealed massive bleeding from a ruptured spleen. The patient was successfully resuscitated. She proved to be infected with cytomegalovirus causing idiopathic thrombocytopenic purpura, splenomegaly and splenic rupture. She was treated for 14 days with ganciclovir and meropenem and discharged on recovery. Atraumatic splenic rupture caused by viral infection is a rare condition although well described. In the case of our patient, thrombocytopenia added to the severity of the splenic rupture. A multidisciplinary team approach was essential for the management and the eventual recovery of the patient.

Topics: Adult; Antiviral Agents; Cytomegalovirus; Cytomegalovirus Infections; Emergencies; Female; Ganciclovir; Heart Arrest; Humans; Meropenem; Rupture, Spontaneous; Splenectomy; Splenic Rupture; Thienamycins; Thrombocytopenia; Treatment Outcome

A 59-year-old man presented with a three-month history of back pain, and enhanced computed tomography demonstrated an acutely expanding aneurysm of the descending thoracic aorta with slight erosion of the corresponding vertebrae. Because of suspected infectious or inflammatory etiology, he was managed with a combination of emergency aortic repair using prosthetic graft with omental flap and antibiotic chemotherapy. Haemophilus influenzae was identified from perioperative specimens and the postoperative course was uneventful.

Topics: Aneurysm, Infected; Anti-Bacterial Agents; Aorta, Thoracic; Aortic Aneurysm, Thoracic; Blood Vessel Prosthesis Implantation; Emergencies; Haemophilus Infections; Haemophilus influenzae; Humans; Male; Meropenem; Middle Aged; Surgical Flaps; Thienamycins; Treatment Outcome

Massive hemolysis secondary to sepsis caused by Clostridium perfringens is a rare entity but appears fairly often in the literature. In nearly all published reports, the clinical course is rapid and fatal. We describe the case of a 75-year-old woman with diabetes who was admitted with symptoms consistent with acute cholecystitis. Deteriorating hemodynamics and laboratory findings were consistent with intravascular hemolysis, coagulation disorder, and renal failure. Gram-positive bacilli of the Clostridium species were detected in blood along with worsening indicators of hemolysis. In spite of antibiotic and surgical treatment, hemodynamic support and infusion of blood products, the patient continued to decline and died in the postoperative recovery unit 14 hours after admission. Mortality ranges from 70% to 100% in sepsis due to Clostridium perfringens, and risk of death is greater if massive hemolysis is present, as in the case we report. Only a high degree of clinical suspicion leading to early diagnosis and treatment can improve the prognosis. This bacterium should therefore be considered whenever severe sepsis and hemolysis coincide.

Topics: Acute Kidney Injury; Aged; Anemia, Hemolytic; Anti-Bacterial Agents; Bacteremia; Blood Component Transfusion; Cholecystectomy; Cholecystitis; Clindamycin; Clostridium perfringens; Combined Modality Therapy; Delayed Diagnosis; Diabetes Complications; Emergencies; Fatal Outcome; Female; Gas Gangrene; Hemofiltration; Humans; Meropenem; Norepinephrine; Postoperative Complications; Shock, Septic; Thienamycins

Rhabdomyolysis is associated with infectious diseases in approximately 5% of cases and acute kidney injury occurs in 33-50% of cases. Gangrenous myositis is a deep seated infection of the subcutaneous and muscular tissues. We report the case of an 18 year-old man who was admitted to the emergency room with leg pain, fever, nausea, vomiting and oliguria. Physical examination showed moderate dehydration, peripheral cyanosis and skin necrosis with severe myalgia and no subcutaneous gas. Laboratory findings at admission were: serum urea 111 mg/dL, creatinine 1.3 mg/dL, potassium 6.3 mEq/L, creatine kinase (CK) 112,452 IU/L, aspartate amino transaminase (AST) 1116 IU/L, alanine amino transaminase (ALT) 1841 IU/L, pH 7.31, bicarbonate (HCO3) 11 mEq/L and lactate 4.3 mmol/L. Emergency hemodyalisis was started, and antibiotics were given due to high suspicion for bacterial infection. The patient developed respiratory insufficiency and septic shock needing mechanical ventilation and vasoactive drugs. He presented spontaneous gangrenous myositis in both legs and in his left arm. After 26 sessions of hemodialysis, partial recovery of renal function was observed. He was discharged from the ICU after 38 days, still with leg pain. Acute kidney injury due to rhabdomyolysis should be considered as a possible complication of gangrenous myositis.

Topics: Acute Kidney Injury; Adolescent; Amputation, Surgical; Anti-Bacterial Agents; Anuria; Debridement; Drug Therapy, Combination; Emergencies; Follow-Up Studies; Gangrene; Humans; Intensive Care Units; Leg; Male; Meropenem; Myositis; Renal Dialysis; Rhabdomyolysis; Running; Teicoplanin; Thienamycins; Time Factors