RESUMO
A 50-year-old renal transplant recipient had Salmonella sepsis. When antibiotic therapy failed to eradicate the infection, abdominal aortography revealed an unsuspected mycotic aneurysm. After ligation and aneurysmectomy the patient's blood stream became sterile. Mycotic aneurysm should be considered when Salmonella sepsis is unresponsive to antibiotic therapy.
Assuntos
Aneurisma Infectado/etiologia , Transplante de Rim , Infecções por Salmonella , Aneurisma Infectado/cirurgia , Humanos , Artéria Ilíaca/cirurgia , Masculino , Pessoa de Meia-Idade , Salmonella enteritidisRESUMO
The course of 76 consecutive patients with acute renal failure and severe intra-abdominal infection was reviewed to identify the microorganisms responsible, the factor precipitating reoperation, and prognostic indicators. Peritonitis occurred in 75 patients, 48 of whom had abscesses. Twenty-four patients (32%) survived. Anaerobes and fungi were commonly grown from blood. Gram-negative aerobic blood isolates were associated with the highest mortality. Leukocytosis, physical findings, and fever were factors that prompted reexploration whereas diagnostic procedures played an ancillary role. The finding of specifically correctable conditions at reoperation improved survival (P less than .05). Myocardial infarction and disseminated intravascular coagulation affected survival unfavorably whereas hyperalimentation had a favorable influence (P less than .05). Aggressive medical, nutritional, and surgical management results in improved survival rates in these patients.