Septic shock caused by community-acquired urinary tract infection caused by Klebsiella pneumoniae ESBL+: A case report
More details
Hide details
Department of Anaesthesiology and Intensive Care, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Department of Nursing, School of Public Health, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Lidia Glinka   

Anaesthesiology and Intensive Care Clinical Ward, Clinical University Hospital in Olsztyn, Department of Anaesthesiology and Intensive Care, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn Poland. Tel. +4889 534 54 08.
Submission date: 2018-07-03
Final revision date: 2019-07-10
Acceptance date: 2019-12-19
Online publication date: 2020-04-14
Septic shock is defined as a life-threatening organ failure caused by an abnormal response of the body to infection. Urinary tract infections (UTIs) constitute about 10%–20% of all community-acquired infections and about 40%–50% of hospital-acquired infections. In patients with impaired immunity they may lead to sepsis. Strains of Klebsiella pneumoniae are often multidrug resistant, and therapeutic chances are limited where they occur.

The aim of this paper is to discuss the most recent guidelines in diagnosing and treating sepsis, referring to a clinical case report.

Case study:
The study presents a case of septic shock in a 44-year-old female patient in a community-acquired UTI caused by K. pneumoniae extended-spectrum β-lactamases (ESBL+).

Results and discussion:
The course of septic shock proved fatal. As the stay in the intensive care unit (ICU) was short, this precluded implementing full diagnostic procedures and identifying the source of infection. A post mortem examination was performed to establish the cause of death and aetiology of the infection.

K. pneumoniae ESBL+ has become a growing epidemiological problem in Poland and all over the world. This pathogen increasingly often leads to community-acquired infections and its multidrug resistance makes the applied therapies ineffective. Diabetes, one of the modern lifestyle diseases, impairs resistance and accelerates rapidly progressing septic shock with multiple organ failure. Late diagnosis of sepsis, because of considerable metabolic and cellular changes, brings about tragic results. Despite implementing new diagnostic methods and therapies, the mortality rate in sepsis still remains very high.

None declared.
None declared.
Kübler A, Nestorowicz A, Gaszyński W. Defeat sepsis. Anestezjol Intens Ter. 2004;4:304–309 [in Polish].
Chmielewska SJ, Fiedoruk K, Daniluk T, Ściepuk M, Kaczmarzyk D, Leszczyńska K. Significance of uropathogenic strains of Escherichia coli (UPEC) in the pathogenesis of urinary tract infections. Post Mikrobiol. 2016;55(1):45–56 [in Polish].
Ravichitra KN, Hema Prakash P, Subbarayudu S, Sreenivasa Rao U. Isolation and antibiotic sensitivity of Klebsiella pneumoniae from pus, sputum and urine samples. Int J Curr Microbiol App Sci. 2014;3(3):115–119.
Sękowska A, Gospodarek E, Kusza K. The prevalence of infections and colonisation with Klebsiella pneumoniae strains isolated in ICU patients. Anaesthesiol Intensive Ther. 2014; 46(4):280–283.
National Reference Center for Drug Susceptibility Systemic. Report of the National Reference Center for Antimicrobial susceptibility Occurrence of Enterobacteriaceae (Klebsiella pneumoniae) producing carbapenem New Delhi type in Poland in the first quarter of 2017. Warszawa; 2017. Accessed: May 23, 2018 [in Polish].
Koh GC, Peacock SJ, van der Poll T, Wiersinga WJ. The impact of diabetes on the pathogenesis of sepsis. Eur J Clin Microbiol Infect Dis. 2012;31(4):379–388.
Dooley KE, Chaisson RE. Tuberculosis and diabetes mellitus: convergence of two epidemics. Lancet Infect Dis. 2009;9(12):737–746.
Fine MJ, Smith MA, Carson CA, et al. Prognosis and outcomes of patients with community aquired pneumonia. A meta-analysis. JAMA. 1996;275(2):134–141.
Thomsen RW, Hundborg HH, Lervang HH, Johnsen SP, Schønheyder HC, Sørensen HT. Diabetes mellitus as a risk and prognostic factor for community-acquired bacteremia due to enterobacteria: a 10-year, population-based study among adults. Clin Infect Dis. 2005;40(4):628–631.
Falangas ME, Alexiou VG, Giannopoulou KP, Siempos II. Risk factors for mortality in patients with emphysematous pyelonephritis: a meta-analysis. J Urol. 2007;178(3 Pt 1):880–885.
Osuchowski MF, Craciun FL, Schuller E, Sima C, Gyurko R, Remick DG. Untreated type 1 diabetes increases sepsis-induced mortality without inducing a prelethal cytokine response. Shock. 2010;34(4):369–376.
Esper AM, Moss M, Lewis CA, Nisbet R, Mannino DM, Martin GS. The role of infection and comorbidity: Factors that influence disparities in sepsis. Crit Care Med. 2006;34(10):2576–2582.
Brun-Buisson C, Doyon F, Carlet J, et al. Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units. JAMA. 1995;274:968–974.
Vincent JL, Preiser JC, Sprung CL, Moreno R, Sakr Y. Insulin-treated diabetes is not associated with increased mortality in critically ill patients. Crit Care. 2010;14(1):R12.
Carton JA, Maradona JA, Nuno FJ, Fernandez Alvarez R, Perez-Gonzalez F, Asensi V. Diabetes mellitus and bacteraemia: a comparative study between diabetic and non-diabetic patients. Eur J Med. 1992;1(5):281–287.
Graham BB, Keniston A, Gajic O, Trillo Alvarez CA, Medvedev S, Douglas IS. Diabetes mellitus does not adversely affect outcomes from critical illness. Crit Care Med. 2010;38(1):16–24.
Rhodes A, Evans LE, Alhazzani W, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Intensive Care Med. 2017;43(3):304–377.
Brusselaers N, Vogelaers D, Blot S. The rising problem of antimicrobial resistance in the intensive care unit. Ann Intensive Care. 2011;1:47.
Pitout JD. Infections with extended-spectrum beta-lactamase-producing Enterobacteriaceae: changing epidemiology and drug treatment choices. Drugs. 2010;70(3):313−333.
Zhanel GG, DeCorby M, Ling N, et al. Antimicrobial-resistant pathogens in intensive care units in Canada: results of the Canadian National Intensive Care Unit (CAN-ICU) Study, 2005–2006. Antimicrob Agents Chemother. 2008;52(4):1430–1437.
Knathe H, Shah P, Krcmery V, Antal M, Mitsuhashi S. Transferable resistance of cefotaxime, cefoxitin, cefamandole and cefuroxime in clinical isolates of Klebsiella Pneumoniae and Serratia marcenscens. Intection. 1983;11(6):315–317.
Sharma M, Pathak S, Srivastava P. Prevalence and antibiogram of extended spectrum β-lactamase (ESBL) producing Gram negative bacilli and further molecular characterization of ESBL producing Escherichia coli and Klebsiella spp. J Clin Diagn Res. 2013;7(10):2173–2177.
An D, Rodrigues B. Role of changes in cardiac metabolism in development of diabetic cardiomyopathy. Am J Physiol Heart Circ Physiol. 2006;291(4):H1489–H1506.
Ratnadeep B, Oudit GY, Wang X, et al. Type 1 diabetic cardiomyopathy in the Akita (Ins2WT/C96Y) mouse model is characterized by lipotoxicity and diastolic dysfunction with preserved systolic function. Am J Physiol Heart Circ Physiol. 2009;297(6):H2096–H2108.
Geerlings SE. Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents. 2008;31(1):S54–S57.