title: Citrobacter braakii bacteremia-induced septic shock after colonoscopy preparation with polyethylene glycol in a critically ill patient: a case report.
abstract: BACKGROUND
  Polyethylene glycol (PEG) is widely used for bowel cleaning in preparation for colonoscopy because of its safety. Septic shock after PEG preparation is an extremely rare complication. Herein, we describe a case of septic shock that occurred immediately after colonoscopy preparation with PEG.
  
  
  METHODS
  A 75-year-old Japanese male who had previously developed diabetes after total pancreatectomy received PEG in preparation for colonoscopy. He had been admitted to the emergency intensive care unit 4 days earlier due to hematochezia presenting with shock. He ingested PEG to prepare for a colonoscopy examination, which was performed to identify the source of his bleeding over a 5-h period, but suddenly exhibited septic shock and markedly elevated procalcitonin levels. A blood culture subsequently revealed Citrobacter braakii. Immediate resuscitation and intensive care with appropriate antibiotics improved his condition.
  
  
  CONCLUSIONS
  Clinicians should be aware of the possibility of deteriorating conditions after bowel preparation with PEG among severely ill patients with recent episodes of hemorrhagic shock.
authors.affiliation: Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan. tyumoto@cc.okayama-u.ac.jp.
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yumoto
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Kono
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Kawano
authors.affiliation: Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kamoi
authors.affiliation: Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Atsuyoshi
authors.initials: A
authors.lastname: Iida
authors.affiliation: Department of Clinical Laboratory, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Motoko
authors.initials: M
authors.lastname: Nose
authors.affiliation: Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Sato
authors.affiliation: Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Toyomu
authors.initials: T
authors.lastname: Ugawa
authors.affiliation: Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Okada
authors.affiliation: Department of Acute Care and Primary Care Medicine, Kawasaki Medical School Hospital, 577 Matsushima, Kurashiki-shi, Okayama, 701-0192, Japan.
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Ujike
authors.affiliation: Advanced Emergency and Critical Care Medical Center, Okayama University Hospital, 2-5-1 Kita-ku, Shikata-cho, Okayama-shi, Okayama, 700-8558, Japan.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000368:Aged; D044466:Asian People; D001769:Blood / Q000382:microbiology; D002954:Citrobacter / Q000302:isolation & purification*; D016638:Critical Illness; D004756:Enterobacteriaceae Infections / Q000139:chemically induced* / Q000150:complications*; D006801:Humans; D008297:Male; D011092:Polyethylene Glycols / Q000008:administration & dosage / Q000009:adverse effects*; D012772:Shock, Septic / Q000209:etiology* / Q000473:pathology*
chemical_list: D011092:Polyethylene Glycols
keywords: Case report; Citrobacter braakii; Colonoscopy; Polyethylene glycol; Septic shock