A rare case of Pseudomonas aeruginosa bacteremia in a newbor
A full-term male infant weighing 3.2 kg was born by spontaneous vaginal delivery to a prima gravid mother without premature rupture of membranes or intrauterine stress. He was exclusively breastfed from birth until 27 days of life when he was hospitalized due to 2 days of abdominal distention and vomiting. The patient experienced mild watery diarrhea for 1 day before the onset of abdominal distention and vomiting. Physical examination revealed a low fever, a distended abdomen with the absence of bowel sounds, and slightly cool limbs without delayed capillary filling. Blood tests showed a white blood cell count of 14 780/µL with 81% neutrophils, slight anemia, normal platelet count level, and a markedly elevated CRP concentration of 104.2 mg/L. Abdominal X-rays suggested the presence of free gas under the diaphragm. Intravenous administration of imipenem cilastratin sodium and emergency abdominal surgery was performed.

Intraoperative findings revealed a large amount of yellowish-green cloudy pus, multiple areas of focal necrosis across the entire small intestine, and 58 circular perforations surrounded by blackened, necrotic bowel tissues sitting on red, crater-shaped protrusions. Wedge resection of the necrotic bowel and repair of the perforated sites were immediately performed. Histopathology of the resected small intestine showed a large number of acute and chronic inflammatory cell infiltrations with purulent inflammation in the intestinal wall, muscular congestion and edema, local loss of mucosa with necrosis to the serosa, dilatation of local small blood vessels in the submucosa, and massive red blood cells in the stroma near-vessel wall. P. aeruginosa, which was sensitive to imipenem, meropenem, and amikacin, was detected in cultures of venous blood and peritoneal exudate.

The post-operative diagnosis was extensive perforations in the small intestine associated with neonatal P. aeruginosa bacteremia and acute diffuse peritonitis. The patient showed no postoperative complications, such as intestinal fistula, incision infection, and intestinal adhesions. On the 4th post-operative day, a small amount of feeding was administrated. The patient was discharged on the 17th post-operative day. The baby has been healthy since then, without recurrent infections, malnutrition, intestinal obstruction, or other discomforts.

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