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• W4387248842 abstract "SESSION TITLE: Critical Care Case Report Posters 22 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Subdural empyema remains a relatively uncommon entity typically associated with surgery, trauma or head and neck infections, with hematogenous spread being a rarely described entity. Most infections are Streptococci, Staphylococci, or anaerobes. Here we describe a case of Escherichia coli infection of the subdural space as a complication of chronic urinary tract infections. CASE PRESENTATION: A 73-year-old female with chronic Escherichia coli urinary tract infections presented to the emergency department with altered mentation, word finding difficulties and weakness. She was febrile and hemodynamically stable, unable to answer beyond yes or no to questioning and with right sided hemiparesis. Approximately 30 minutes after administration of cefepime, vancomycin and metronidazole in the emergency room she had complete resolution of her symptoms. Imaging of her head with CT showed a small, left sided, subacute, subdural hemorrhage and midline shift of 2mm. Given her significant resolution of symptoms after antimicrobial therapy a contrasted MRI brain was obtained which confirmed subdural empyema.Neurosurgery was consulted for evacuation; she was started on Keppra and the patient was admitted to the ICU with continued antimicrobial therapy. She was taken to the operating room for craniotomy with successful evacuation of purulent fluid in the subdural space. Cultures obtained from the urine, blood and subdural space were found to be identical strains of Escherichia coli. Post-operatively the patient developed expressive aphasia and right upper extremity weakness that gradually improved during her hospitalization and acute rehab. Antimicrobial therapy was continued for 8 weeks with continued gradual improvement in her neurologic deficits. DISCUSSION: Classically, subdural empyema is secondary to direct seeding of the subdural space by surgery or trauma or by direct extension from infections, most frequently of the frontal sinus. Occasionally, indirect extension from thrombophlebitis or hematogenous spread has been described enabled by the diploic veins of Breschet, though most often this is in the setting of a known prior subdural hematoma. When found in the subdural space, Escherichia coli has been most often described in children and is often due to direct seeding or profound sepsis. In this case the presumed mechanism was hematogenous spread from a urinary tract infection to a previously unknown subdural hemorrhage. Treatment involves craniotomy with prolonged antimicrobial therapy for 6-8 weeks. Residual neurologic deficits are common and are often only partially resolving. CONCLUSIONS: Here we describe a rare case of subdural empyema, with a seldom described causative organism that was found to be secondary to hematogenous spread from a urinary tract infection and without a clear inciting injury, causative of her subdural hemorrhage. REFERENCE #1: Fernández-de Thomas RJ, De Jesus O. Subdural Empyema. [Updated 2022 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK557829/?report=classic REFERENCE #2: Agrawal, Amit MCh*; Timothy, Jake FRCS†; Pandit, Lekha MD‡; Shetty, Lathika MD§; Shetty, J.P. MD∥. A Review of Subdural Empyema and Its Management. Infectious Diseases in Clinical Practice 15(3):p 149-153, May 2007. | DOI: 10.1097/01.idc.0000269905.67284.c7 REFERENCE #3: French H, Schaefer N, Keijzers G, et al. Intracranial Subdural Empyema: A 10-Year Case Series. The Ochsner Joural 14:188-194, 2014 DISCLOSURES: No disclosure on file for Chelsea Garner No relevant relationships by Stephen Goertzen No disclosure on file for Michael Gonzales No relevant relationships by John Levasseur" @default.
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• W4387248842 date "2023-10-01" @default.
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• W4387248842 title "A RARE CASE OF ESCHERICHIA COLI SUBDURAL EMPYEMA: A CASE REPORT" @default.
• W4387248842 doi "https://doi.org/10.1016/j.chest.2023.07.1387" @default.
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