2018 Volume 15 Issue 3 Pages 257-261
A 79-year-old man with intraductal papillary mucinous neoplasm underwent pancreaticoduodenectomy. Due to prolonged pancreatic fistula after surgery, Enterococcus faecalis was detected from the drain for which Tazobactam/Piperacillin was started. Enterobacter cloacae (ESBL) was then detected from ascites, for which antibiotics was changed to Imipenem/Cilastatin. Then pancreatic fistula and post-operative infection were improved and patient was discharged on postoperative day 71. However, 13 days after discharge, he was re-admitted to the hospital for abdominal pain and fever. CT demonstrated no abscess, but blood biochemistry showed inflammatory response, for which Imipenem/Cilastatin was re-started. Then Carbapenem-resistant Enterobacter cloacae and Enterococcus raffinosus were detected from blood cultures, and therefore antibiotics were changed to high dose amikacin, meropenem and vancomycin based on drug sensitivity of the two types of bacteria. Due to renal dysfunction, vancomycin was changed to teicoplanin, and the inflammatory response subsided. The patient was discharged without any complication on hospital day 51.
