A Fatal Case of Providencia Sepsis
A 42-year-old diabetic male was admitted in our Intensive Care Unit,
a follow-up case of bilateral renal-calculus, who underwent left sided percutaneous
nephrolithotomy in some peripheral hospital.
There was alleged history of massive bleeding intra-operatively owing to injury to renal
parenchyma. There was documented placement of double J stent
and renal parenchymal laceration repair.
Patient had received four units of packed cell volume during intra-operative period. He was
shifted to the ICU, intubated requiring high vasopressor support,
oliguria and high total leucocyte count (TLC) 38,000/mm3.
Procalcitonin levels were very high and were suggestive of high risk
of sepsis and septic shock (Table 2).
Patient had sudden deterioration over few days leading to full ventilator
support requiring high dosage of vasopressor support.
His chest X-ray were suggestive of bilateral acute respiratory distress
syndrome, requiring very high fraction of oxygen.
The most common source of sepsis is via urinary route as P.
stuartii adheres directly to the urinary catheters, and adheres
to uroepithelial cells via fimbriae.
Godebo et al2 suggested that 75% of Providencia isolates were multidrug
resistant and Linhares et al3 identified Providencia species as the
most common cause of multi drug resistant urinary tract infection.
Over 90% of isolates were resistant to aminoglycosides, cephalosporins,
20% to other penicillins, quinolones, sulphonamides.
Ten percent were resistant to II-III generation cephalosporins and 5%
to aztreonam.
Urol Androl Open J. 2017; 2(1): 4-7. doi: 10.17140/UAOJ-2-112
