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• W2977998241 abstract "Hafnia alvei is a commensal, gram-negative bacterium that is found within both the gastro-intestinal and respiratory tracts. It is considered normal flora and rarely causes pathogenic infections in immunocompetent individuals. We present a young, and otherwise healthy, female who became acutely ill post-ERCP. A 39-year-old female with past medical history most significant for acute calculous cholecystitis status post laparoscopic cholecystectomy with resulting biliary stricture status post endoscopic sphincterectomy with stent placement, underwent ERCP for stent retrieval 2 months later. During the ERCP, the initial stent was removed, 2 further stents were placed, and the patient was then admitted for closer observation for pain and nausea control. On the third day of admission, the patient began to experience fever, chills, became tachycardic, tachypneic and hypotensive. Due to this acute change in status and with her recent GI manipulation, laboratory work, blood cultures and CT abdomen/pelvis with contrast were done in an attempt to uncover a source of her severe sepsis. Imaging showed post-surgical changes in the RUQ with non-migrated biliary stents and intrahepatic biliary air. LFTs, lipase, CBC and CMP were within normal limits. Blood cultures grew Enterococcus faecalis and Hafnia alvei, both sensitive to IV Piperacillin and Tazobactam. Infectious Disease was consulted and the patient was discharged on a 2-week course of continuous IV Piperacillin and Tazobactam, which upon completion, was transitioned to a 1-week course of PO Levofloxacin and Augmentin, with full resolution of infection and abdominal symptoms. Complications from ERCP can range from relatively benign to life threatening. ERCP is generally considered a safe procedure that can lead to transient, and insignificant, bacteremia in immunocompenent individuals. The etiology of sepsis is thought to be due to bacterial translocation after manipulation within the GI tract, such as was the case with our patient. Hafnei alvei is a rare cause of systemic infections, and usually only presents in immuno-compromised patients. Our case is unusual for two reasons; one being that it caused widespread septicemia, and two, that it occurred in an otherwise healthy and immunocompenent young female. Clinicians must be aware of the possibility of developing potentially fatal infections post-ERCP and act quickly with appropriate management in order to improve survival outcomes." @default.
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• W2977998241 date "2016-10-01" @default.
• W2977998241 modified "2023-09-24" @default.
• W2977998241 title "Hafnia Alvei: Friend or Foe? A Rare Cause of Post-ERCP Sepsis" @default.
• W2977998241 doi "https://doi.org/10.14309/00000434-201610001-01545" @default.
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