Abstract
Intravascular devices aid in drug administration and fluid replacement for hospitalized patients and are thus an integral part of modern medical care; however, poor aseptic technique and improper manipulation of infusion devices increase the risk of infections secondary to catheterization that can progress to sepsis and septic shock. We report the case of a woman who presented with altered mental status after receiving normal saline through an intravenous catheter placed by a medically untrained individual. Less than 24 h following her initial presentation to emergency medical services the patient became unresponsive to multiple vasopressors and broad-spectrum antibiotics and succumbed to septic shock. At autopsy, the decedent had enumerable hemorrhagic lesions consistent with septic emboli, and microscopic examination revealed clusters of coccoid-appearing bacteria. Cultures of the intravenous fluid and IV tubing collected at the decedent’s home grew methicillin-resistant Staphylococcus aureus (MRSA), which was consistent with ante-mortem cultures. This case highlights the rapid clinical deterioration and autopsy presentation of MRSA sepsis due to contamination of the intravenous delivery system.
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References
Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.
Angus DC, Van der Poll T. Severe sepsis and septic shock. N Engl J Med. 2013;369:840–51.
Martin GS. Sepsis, severe sepsis and septic shock: changes in incidence, pathogens and outcomes. Expert Rev Anti-Infect Ther. 2012;10:701–6.
Lowy FD. Staphylococcus aureus infections. N Engl J Med. 1998;339:520–32.
Chen LF. The changing epidemiology of methicillin-resistant Staphylococcus aureus: 50 years of a superbug. Am J Infect Control. 2013;41:448–51.
Boucher H, Miller LG, Razonable RR. Serious infections caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2010;51(Suppl 2):S183–97.
Sato A, Nakamura I, Fujita H, Tsukimori A, Kobayashi T, Fukushima S, et al. Peripheral venous catheter-related bloodstream infection is associated with severe complications and potential death: a retrospective observational study. BMC Infect Dis. 2017;17:434.
Eggimann P. Diagnosis of intravascular catheter infection. Curr Opin Infect Dis. 2007;20:353–9.
Sitges-Serra A, Linares J, Garau J. Catheter sepsis: the clue is the hub. Am J Infect Control. 1985;13:282.
Lieblich SE, Forman D, Berger J, Gold BD. Septicemia secondary to administration of a contaminated intravenous fluid. J Oral Maxillofac Surg. 1984;42:680–2.
Kumar A, Kethireddy S, Darovic GO. Catheter-related and infusion-related sepsis. Crit Care Clin. 2013;29:989–1015.
Regev R, Dolfin T, Zamir C. Multiple brain abscesses in a premature infant: complication of Staphylococcus aureus sepsis. Acta Paediatr. 1995;84:585–7.
Lai PH, Lin SM, Pan HB, Yang CF. Disseminated miliary cerebral candidiasis. Am J Neuroradiol. 1997;18:1303–6.
Johnsson D, Mölling P, Strålin K, Söderquist B. Detection of Panton-valentine leukocidin gene in Staphylococcus aureus by LightCycler PCR: clinical and epidemiological aspects. Clin Microbiol Infect. 2004;10:884–9.
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Abernathy, K., Fiester, S. & Fulcher, J.W. Miliary pattern MRSA sepsis following clandestine intravenous infusion. Forensic Sci Med Pathol 15, 267–271 (2019). https://doi.org/10.1007/s12024-018-0077-5
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DOI: https://doi.org/10.1007/s12024-018-0077-5