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Abstract
Background
A 69-year-old woman underwent elective surgical repair of an abdominal aortic aneurysm.
Intraoperative lesions were intestinal and splenic, requiring performing segmental
bowel resection and splenectomy. By hemodynamic instability the patient was maintained
on mechanical ventilation in norepinephrine and was transferred to the ICU. After
3 days she had fever, tachycardia, hypotension and anuria, with output fetid and purulent
secretion by the tracheal tube. Chest X-ray showed opacity in the right lung; cultures
were collected and cefepime initiated empirically for treatment of ventilator-associated
pneumonia. Acinetobacter baumannii was isolated sensitive only to polymyxin-E in the
sample of tracheal secretions. An exchange of antimicrobial therapy was made, but
the patient developed refractory shock and died.
Materials and methods
We report the case of a patient with septic shock.
Results
Despite the upgrading of intensive therapies with the presence of increasingly prepared
professionals and all of the technological and scientific developments that occurred
in the last 10 years, sepsis remains a major challenge for contemporary medicine.
Mortality rates may vary from 20 to 80%. Several factors contribute to this high mortality
rate, such as the growing population of patients aged over 65 years with various chronic
diseases, the most frequent use of invasive procedures, increased demand for immunocompromised
patients and the development of nosocomial microorganism infections increasingly resistant
to antimicrobial agents. Besides the pathophysiology, evidence substantiated that
early intervention reduces mortality in severe sepsis and thus several ICUs have sought
to improve the quality of clinical management of septic patients. In 2002, the Medical
Society of Intensive American (SCCM) and European (ESICM) together with the International
Sepsis Forum initiated the Surviving Sepsis Campaign (SSC). The SSC initiative was
based on six strategies, including: implement surveillance sepsis; improve the early
diagnosis and safety; establish protocols for treatment and early intervention; create
programs continuing professional education; proposed therapy post-ICU; and develop
global standards for intensive care.
Conclusions
The emergence of antimicrobial-resistant microorganisms is a growing problem worldwide
and this complicates the choice of empirical antimicrobials and can compromise the
evolutionary outcome of patients.
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