Management of critical patient infected with extended spectrum beta-lactamase (ESBL) producing Escherichia Coli

Abstract

Introduction : Antibiotics has been widely used in medical practices nowadays. Antibiotics usage is often massively performed and sometimes not as indicated. Un-judicious and overuse of antibiotics that is not correlated with clinical pathways could result in antimicrobial resistance. Extended Spectrum Beta-Lactamase (ESBL) is an enzyme that has a capability of hydrolysing and deactivate Penicillin group antibiotics, 1st, 2nd, 3rd generation cephalosporin, as well as Monobactam antibiotics, further will cause resistance to those antibiotics. These matters will make it difficult to choose antibiotics. This article will discuss patients with Escherichia coli infection with ESBL in septic shock and its management. Case Presentation: Thirty five years old female with BMI 22 Kg/m2 was admitted to ICU with septic shock caused by infected sacral pressure sore. She has a history of traffic accidents and was mechanical ventilated 6 months ago. We performed septic shock management according to the Surviving Sepsis Campaign recommendation along with other supportive management. Macro (temperature, heart rate, mean arterial blood pressure) and micro haemodynamic (lactate, pCO2 gap, central venous pressure, vena cava inferior diameter) changed on day 3. We change the antibiotic according to the culture result. Escherichia Coli was found in blood culture with ESBL. The antibiotics were Amikacin combined with Tigecycline. Improvement was seen on the fifth day, then stopped the vasopressor, on day six weaned the mechanical ventilation. Conclusion: Resuscitation and rapid source control of infection focus, combined with appropriate antibiotic choice become the key principle in managing patients with septic shock caused by Escherichia coli with ESBL.