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Abdominal sepsis caused by Enterobacter ludwigii in a 72-year-old patient on chronic hemodialysis, with lack of vascular accesses, complicated by cholecystitis and with non-occlusive thrombosis of the superior vena cava and right atrium

Igor Romaniouk, Iyad Abuward Abu-sharkh, Maria Jesus Isorna Porto, Manuel Fidalgo, Rafael Alonso, Suleuka Puello Martinez, Carmen Vasquez, Maria Porto Bujia, Maria Teresa Gutierrez, Candido Diaz Rodriguez

Infections are very common complications among patients on chronic hemodialysis. Hemodialysis patients with a catheter have a 2- to 3-fold increased risk of hospitalization for infection and death compared with patients with an arteriovenous fistula or graft. The most common causative pathogens are gram-positive bacteria, according to several studies, Staphylococcus aureus and coagulase-negative staphylococci accounting for 40% to 80% of Catheter-related bloodstream infections (CRBSIs). Gram-negative organisms cause 20% to 40% CRBSIs, whereas polymicrobial infections (10%-20%) and fungal infections (<5%) are less common. Abdominal infections are not common in hemodialysis patients. Other complications, such as the loss of the vascular access many times imply immediate threat to the patient’s life. In most severe cases of infections, it requires removal of the catheter. When the source is abdominal, E. coli followed by Bacteroides spp are involved. We present the evolution and treatment of a 72-year-old woman, on chronic hemodialysis, with an exhaustion of most of vascular accesses, who suffers a sepsis with initial suspicion of a catheter infection. Subsequent studies revealed a biliary infection secondary to Enterobacter ludwigii. The patients additionally complicates with a non-occlusive thrombosis of the superior vena cava and right atrium.