| Summary: | Intro: Klebsiella pneumonia remains a major pathogen causing cystitis and pneumonia. Capsular serotypes K1 and K2 may cause invasive disease such as liver abscesses and endogenous endophthalmitis but rarely causing infective endocarditis due to its poor adherence to cardiac valves Methods: This case was co-managed in general orthopaedic ward at tertiary hospital Malaysia. Findings: 52 year old fisherman with no previous illness presented with right neck swelling and left ankle swelling for 2 weeks.. Upon presentation the patient was diagnosed to have diabetes ketoacidosis (DKA) which resolved with treatment with hydration and insulin. In ward he underwent incision and drainage for the right neck abscess and extensive wound debridement with arthrotomy and washout for his left limb and ankle. All post operative and blood culture revealed Klebsiella pneumonia, sensitives to all antibiotic groups except for ampicillin. Ultrasound abdomen showed no intra-abdominal collections and an ophthalmic examination showed no evidence of endophthalmitis. His cardiovascular examination revealed systolic murmur over mitral area with no radiations. Echocardiogram confirmed the findings of vegetation at left coronary cusp of aortic valve measuring 0.2 cm2. Initially he was started on intravenous ceftazidime and deescalate to intravenous amoxycillin-clavulanic acid based on culture sensitivity. Later, this patient had another second look wound debridement of left lower limb in view of the wound looked unhealthy with pus and sloughs. Clinically the patient improved with surgical interventions and antibiotics. He received total 6 week of antibiotic and his repeated echocardiogram showed resolved vegetation. Conclusion: This case illustrates the case of Klebsiella bacteraemia with infective endocarditis, that need a thorough clinical examination and investigations to look for the complications as it will affect the total antimicrobial duration. Decision of single or combined antimicrobial should be based on culture sensitivity as well as clinical responds of the patient, as this disease carries a significant mortality rate.
|
|---|