title: Sepsis resulting from Enterobacter aerogenes resistant to carbapenems after liver transplantation.
abstract: BACKGROUND
  Sepsis due to Enterobacter aerogenes (E. aerogenes) is rare after liver transplantation but is also a serious infection that may cause liver abscess. The purpose of this case report is to relate an unusual presentation of liver transplantation to show how successive treatment can be an appropriate option in septic patients after liver transplantation.
  
  
  METHODS
  We report on a patient with liver transplantation who developed sepsis due to extended spectrum beta-lactamases and AmpC-producing E. aerogenes.
  
  
  RESULTS
  A 39-year-old man had a biliary fistula and then was found to have multiple liver abscesses through abdominal ultrasound and an abdominal computed tomography scan, and carbapenem-sensitive E. aerogenes infection was confirmed. The patient was not successfully treated with conservative treatment consisting of intravenous carbapenems, percutaneous transhepatic cholangial drainage, and biliary stent placement by endoscopic retrograde cholangiopancreatography, so a second liver transplantation followed. Carbapenem-resistant E. aerogenes was detected in bile and blood after a five-week course of carbapenem therapy. The patient developed septic shock and multiple organ dysfunction syndrome.
  
  
  CONCLUSIONS
  We first report an unusual case of sepsis caused by E. aerogenes after liver transplantation in China. Carbapenem-resistant E. aerogenes finally leads to uncontrolled sepsis with current antibiotics. We hypothesize that the infection developed as a result of biliary fistula and predisposing immunosuppressive agent therapy. Further research is progressing on the aspect of immunomodulation therapy.
authors.affiliation: Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
authors.forename: Hao
authors.initials: H
authors.lastname: Chen
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Ya-Gang
authors.initials: YG
authors.lastname: Chen
authors.forename: Yun-Song
authors.initials: YS
authors.lastname: Yu
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Zheng
authors.forename: Lan-Juan
authors.initials: LJ
authors.lastname: Li
mesh_terms: D000328:Adult; D015780:Carbapenems / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D021902:Enterobacter aerogenes / Q000502:physiology*; D004756:Enterobacteriaceae Infections / Q000150:complications / Q000209:etiology*; D006801:Humans; D008100:Liver Abscess / Q000382:microbiology; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D009102:Multiple Organ Failure / Q000382:microbiology; D011182:Postoperative Care; D012772:Shock, Septic / Q000382:microbiology
chemical_list: D015780:Carbapenems