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International Journal of Emergency Medicine

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Open Access 01-12-2021 | Antibiotic | Case report

Case report: appendicitis induced Staphylococcus aureus and Klebsiella pneumoniae bacteremia in a young healthy male

Authors: Jan Arne Deodatus, Sander Ferdinand Emiel Paas, Gerrit Hendrik Johan Wagenvoort, Marije Matilde de Kubber

Published in: International Journal of Emergency Medicine | Issue 1/2021

Abstract

Background

Appendicitis is one of the most frequently encountered conditions at the emergency department. Distinction is made between complicated and uncomplicated appendicitis. Complicated appendicitis may cause serious intra-abdominal infection, bacteremia, or sepsis. Emergency health providers should be highly alert to any early signs indicating such complications.

Case presentation

We present the case of a healthy young male with a gangrenous appendicitis, who received antibiotics and underwent appendectomy. Blood cultures showed unequivocal Staphylococcus aureus and concomitant Klebsiella pneumoniae bacteremia requiring prolonged antibiotic treatment and further diagnostic evaluation.

Conclusions

Although rare, appendicitis can cause Staphylococcus aureus and Klebsiella pneumoniae bacteremia with extensive implications for workup and antibiotic management. Our case stresses the importance of obtaining cultures in patients with suspicion of bacteremia given its consequences for clinical management.

Powers RD, Guertler AT. Abdominal pain in the ED: stability and change over 20 years. Am J Emerg Med. 1995;13(3):301–3. https://doi.org/10.1016/0735-6757(95)90204-X.CrossRefPubMed

Hardin DMJ. Acute appendicitis: review and update. Am Fam Physician. 1999;60(7):2027–34.PubMed

Ferris M, Quan S, Kaplan BS, Molodecky N, Ball CG, Chernoff GW, et al. The global incidence of appendicitis. Ann Surg. 2017;266(2):237–41. https://doi.org/10.1097/SLA.0000000000002188.CrossRefPubMed

Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(10000):1278–87. https://doi.org/10.1016/S0140-6736(15)00275-5.CrossRefPubMed

Moawad MR, Dasmohapatra S, Justin T, Keeling N. Value of intraoperative abdominal cavity culture in appendicectomy: a retrospective study. Int J Clin Pract. 2006;60(12):1588–90. https://doi.org/10.1111/j.1742-1241.2006.00774.x.CrossRefPubMed

Davies HOB, Alkhamesi NA, Dawson PM. Peritoneal fluid culture in appendicitis: review in changing times. Int J Surg. 2010;8(6):426–9. https://doi.org/10.1016/j.ijsu.2010.06.016.CrossRefPubMed

Lau WY, Teoh-Chan CH, Fan ST, Yam WC, Wong SH. The bacteriology and septic complication of patients with appendicitis. Ann Surg. 1984;200(5):576–81. https://doi.org/10.1097/00000658-198411000-00003.CrossRefPubMedPubMedCentral

Jeon HG, Ju HU, Kim GY, Jeong J, Kim MH, Jun JB. Bacteriology and changes in antibiotic susceptibility in adults with community-acquired perforated appendicitis. PLoS One. 2014;9(10):1–7.

Reinisch A, Malkomes P, Habbe N, Bechstein WO, Liese J. Bad bacteria in acute appendicitis: rare but relevant. Int J Colorectal Dis. 2017;32(9):1303–11. https://doi.org/10.1007/s00384-017-2862-0.CrossRefPubMed

10.

Safaya A, Stockberger M, Li KI, Wang G, Pee S, Stringel G. Methicillin-resistant Staphylococcus aureus appendicitis. J Pediatr Surg Case Reports. 2018;32(December 2017):43–5. https://doi.org/10.1016/j.epsc.2018.01.019.CrossRef

11.

Salemis NS. Acute appendicitis presenting with Klebsiella pneumoniae septicemia due to bacterial translocation. Am J Emerg Med. 2009;27(8):1023.e3–4.CrossRef

12.

Kaur CP, Vadivelu J, Chandramathi S. Impact of Klebsiella pneumoniae in lower gastrointestinal tract diseases. J Dig Dis. 2018;19(5):262–71. https://doi.org/10.1111/1751-2980.12595.CrossRefPubMed

13.

Claassen-Weitz S, Shittu AO, Ngwarai MR, Thabane L, Nicol MP, Kaba M. Fecal carriage of Staphylococcus aureus in the hospital and community setting: a systematic review. Front Microbiol. 2016;7(449):449. https://doi.org/10.3389/fmicb.2016.00449.

14.

Myles IA, Datta SK. Staphylococcus aureus: an introduction. Semin Immunopathol. 2012;34(2):181–4.CrossRef

15.

van Hal SJ, Jensen SO, Vaska VL, Espedido BA, Paterson DL, Gosbell IB. Predictors of mortality in Staphylococcus aureus bacteremia. Clin Microbiol Rev. 2012;25(2):362–86.CrossRef

16.

Horino T, Sato F, Hosaka Y, Hoshina T, Tamura K, Nakaharai K, et al. Predictive factors for metastatic infection in patients with bacteremia caused by methicillin-sensitive staphylococcus aureus. Am J Med Sci. 2015;349(1):24–8. https://doi.org/10.1097/MAJ.0000000000000350.CrossRefPubMed

17.

Otto M. Staphylococcal biofilms. Curr Top Microbiol Immunol. 2008;322:207–28. https://doi.org/10.1007/978-3-540-75418-3_10.CrossRefPubMedPubMedCentral

18.

Holland TL, Arnold C, Fowler VG. Clinical management of Staphylococcus aureus bacteremia: a review. JAMA - J Am Med Assoc. 2014;312(13):1330–41. https://doi.org/10.1001/jama.2014.9743.CrossRef

19.

de Greeff SC, Schoffelen AF, Verduin CM. NethMap 2020: Consumption of antimicrobial agents and antimicrobial resistance among medically important bacteria in the Netherlands in 2019/MARAN 2020: monitoring of antimicrobial resistance and antibiotic usage in animals in the Netherlands in 2019. Rijksinstituut voor Volksgezondheid en Milieu RIVM. 2020;NethMap 2020(2020):1-189.

20.

Lee J, Hwang SS, Kim K, Jo YH, Lee JH, Kim J, et al. Bacteremia prediction model using a common clinical test in patients with community-acquired pneumonia. Am J Emerg Med. 2014;32(7):700–4. https://doi.org/10.1016/j.ajem.2014.04.010.CrossRefPubMed

21.

Metersky ML, Ma A, Bratzler DW, Houck PM. Predicting bacteremia in patients with community-acquired pneumonia. Am J Respir Crit Care Med. 2004;169(3):342–7. https://doi.org/10.1164/rccm.200309-1248OC.CrossRefPubMed

22.

Tokuda Y, Miyasato H, Stein GH. A simple prediction algorithm for bacteraemia in patients with acute febrile illness. QJM - Mon J Assoc Physicians. 2005;98(11):813–20. https://doi.org/10.1093/qjmed/hci120.CrossRef

23.

Jones GR, Lowes JA. The systemic inflammatory response syndrome as a predictor of bacteraemia and outcome from sepsis. QJM - Mon J Assoc Physicians. 1996;89(7):515–22. https://doi.org/10.1093/qjmed/89.7.515.CrossRef

24.

Coburn B, Morris AM, Tomlinson G, Detsky AS. Does this adult patient with suspected bacteremia require blood cultures? JAMA - J Am Med Assoc. 2012;308(5):502–11. https://doi.org/10.1001/jama.2012.8262.CrossRef

25.

Shapiro NI, Wolfe RE, Wright SB, Moore R, Bates DW. Who needs a blood culture? A prospectively derived and validated prediction rule. J Emerg Med. 2008;35(3):255–64. https://doi.org/10.1016/j.jemermed.2008.04.001.CrossRefPubMed

26.

Bilik R, Burnweit C, Shandling B. Is abdominal cavity culture of any value in appendicitis? Am J Surg. 1998;175(4):267–70. https://doi.org/10.1016/S0002-9610(98)00019-1.CrossRefPubMed

27.

Akingboye AA, Davies B, Tien T. Pus samples in complicated appendicitis: an important investigation or a waste of resources: a prospective cohort study. Scand J Surg. 2019;108(1):55–60. https://doi.org/10.1177/1457496918783721.CrossRefPubMed

28.

Kenig J, Richter P. The need for culture swabs in laparoscopically treated appendicitis. Wideochirurgia I Inne Tech Maloinwazyjne. 2013;8(4):310–4.

Title: Case report: appendicitis induced Staphylococcus aureus and Klebsiella pneumoniae bacteremia in a young healthy male
Authors: Jan Arne Deodatus
Sander Ferdinand Emiel Paas
Gerrit Hendrik Johan Wagenvoort
Marije Matilde de Kubber
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: Antibiotic
Appendicitis
Appendicitis
Published in: International Journal of Emergency Medicine / Issue 1/2021
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI: https://doi.org/10.1186/s12245-021-00358-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Case report: appendicitis induced Staphylococcus aureus and Klebsiella pneumoniae bacteremia in a young healthy male

Abstract

Background

Case presentation

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Case presentation

Conclusions

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