The patient had a history of congenital malformation of 8 months, female, if she had been born at term.
At 3 days of life she presented a clinical picture compatible with intestinal obstruction, performing intestinal resection and ileostomy; the histological study of the surgical specimen was compatible with pancolonic Hirschprung's disease.
Due to new obstructions, it was necessary to resect part of the small intestine and ileocecal valve, remaining 27 cm of intestine and a functional short bowel syndrome. It required parenteral nutrition from the second progressive day of life to ECA.
Two months later a Broviac central CVC was placed.
During his stay he presented an infection associated with catheter oxacillin-resistant S. aureus, treated with vancomycin for 14 days, at the fourth month of life a diarrhea due to RTV and metronidazole treated with cefuroxime dialyse (EC).
At 6 months, another episode of catheter-related infection due to coagulase-negative Staphylococcus was treated with vancomycin and catheter removal due to persistent fever.
An immunological study was carried out finding an allergy to cow's milk protein, DNA and chicken, so the feeding was changed to Neocate®.
Eight months later, a new fever, with pain and erythema of the perigastrostomy region, a surgical complication was ruled out and treatment with cloxacillin and amikacin was started.
He remained febrile, with increased losses by ileostomy, abdominal ultrasound showed a thickened intestinal loop wall and echocardiography showed no vegetations; he completed 10 days of antimicrobial treatment.
Two weeks later, the patient developed sepsis and was admitted to the Pediatric Intensive Care Unit (PICU).
Among the tests requested, a PCR of 78 mg/lt (previous of 17 mg/lt), hemogram with hematocrit 26%, Hb 8 gr/dl, leukocytes 7,000/mm3 (segmented 74%, beta-HS) stood out.
The patient was treated with volume infusion, with no need for support with vasoactive amines, and vancomycin.
The hemocultives were informed positive to a Gram stalk in study, possible Streptococcus and added to the amikacin scheme.
The susceptibility study of the strain using the NCCLS5 non-pneumonia Streptococcus tables showed resistance to vancomycin, cefoxime and intermediate sensitivity to penicillin.
The patient was treated with clindamycin and amikacin.
The patient remained seated on the fourth day of thermal treatment until the removal of the Broviac catheter and its replacement by a femoral catheter.
The culture of the catheter tip was reported as positive to oxacillin-resistant S. aureus, receiving 12 days of clindamycin and amikacin with good evolution.
It was subsequently reported that isolated Gram-positive cocci (cAL-R hemocultives, studied with API 20 Strep Bio Merieux system, Inc. corresponded to Leuconostoc sp: tetraP (+),
In this case, no molecular study was performed because the strain was not available.
Subsequently, she developed pulmonary thromboembolism that was treated with low molecular weight heparin for a long time and restarted the SCA until reaching the total volume.
She was discharged in good condition.
