Associated with 15 years old, previously healthy, he was admitted to the emergency room after suffering a syncope while practicing an outgoing exercise in a soccer field, subjected to high environmental temperature.
Physical examination revealed a 37.3 °C febricula, blood pressure of 97/54 mmHg, profuse sweating and sinus tachycardia at 179 bpm, and normal cardiorespiratory auscultation.
Hemodynamic stability was achieved after intravenous fluid administration; however, the patient presented fever of 37.8°C, progressive alteration of hepatic and renal function, leukocytosis and elevated muscle enzymes.
She was admitted with a diagnosis of syncope due to heat, sinus tachycardia, acute renal failure, hepatic cytolysis and secondary rabiesolysis.
On the 4th day of hospitalization she presented fever, so the next day two pairs of hemocultives for aerobics and anaerobics were taken.
Despite the use of antipyretics, the patient persisted with fever, up to 39.2°C; vomiting and chills.
The probable focus was the presence of phlebitis secondary to a peripheral venous line in the right forearm, channeled on admission.
For this reason, on day 7 the catheter was removed without sending it to culture.
The patient was admitted with fever until day 9.
Bacterial growth was detected in four hemocultives on day 8.
In McConkey agar, blood, chocolate and Schaedler subcultures, a gram-negative bacillus, negative oxidase, and positive catalase increased.
It was identified as Serratia rubidaea by a 95W panel (Soria Melguizo S.A. Madrid).
Spain), API 20E Gallery (bioMérieux.
Marcy L'Etoile.
France) and MALDI-TOF Microflex mass spectrometry (Brucker.
Ber.
Germany).
The antibiogram by broth microdilution in the 95W panel showed that the microorganism was susceptible to amoxicillin, amoxicillin/clavulanic acid, piperacillin/inate, cefepime resistant cefopenem
The isolate showed decreased susceptibility to ciprofloxacin (MIC 0.4 μg/ml per epsilo) but was susceptible to nalidixic acid (MIC ≤ 16 μg/ml).
The presence of transferable quinolone resistance determinants (TDRQ) qnrA, qnrB, qnrS, qnrC, qnrC, qnrD, qep was investigated by PCR.
In view of the microbiological results and due to the slow improvement of phlebitis, imipenem was started on day 10 of admission.
Complete resolution of phlebitis was achieved on day 7 of treatment and the patient was discharged after completing 10 days of antimicrobial therapy.
