Rapid Succession of Multidrug-Resistant Bacteremia and Candidemia in a Patient with Refractory Pemphigus Vulgaris: A Lethal Therapeutic Challenge
Abstract
Background: Immunosuppressed patients with extensive skin barrier disruption face extraordinary risks for polymicrobial infections. The rapid, sequential emergence of multidrug-resistant (MDR) bacteremia and candidemia in such hosts constitutes a particularly lethal complication with limited therapeutic options.
Case presentation: We report a 74-year-old woman with refractory pemphigus vulgaris (PV), type 2 diabetes mellitus, and chronic obstructive pulmonary disease who developed a cascade of MDR infections over a 14-day hospitalization. Following initial methicillin-resistant Staphylococcus aureus (MRSA) skin colonization, she developed Serratia marcescens bacteremia, subsequently complicated by wound superinfection with carbapenem-resistant Acinetobacter baumannii (CRAB) and multiple Candida species, including the rare yeast Kodamaea ohmeri. Despite sequential antimicrobial escalation-from piperacillin-tazobactam/linezolid to meropenem/amikacin, and finally caspofungin-her condition deteriorated with diabetic ketoacidosis, culminating in the family's decision to pursue discharge with comfort care based on the patient's previously expressed wishes; she died three days later. K. ohmeri demonstrated reduced fluconazole susceptibility (MIC = 8 µg/mL), highlighting the diagnostic and therapeutic challenges posed by emerging fungal pathogens.
Conclusion: This case starkly illustrates the catastrophic potential of rapid, sequential MDR infections in profoundly immunocompromised…
How strong is the evidence?
Evidence Hub reads this as a case report, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
Read the paper
Related studies
- Association of lower urinary tract symptoms and OAB severity with quality of life and mental health in China, Taiwan and South Korea: results from a cross-sectional, population-based study
- Ten-Day Quadruple Therapy Comprising Low-Dose Rabeprazole, Bismuth, Amoxicillin, and Tetracycline Is an Effective and Safe First-Line Treatment for Helicobacter pylori Infection in a Population with High Antibiotic Resistance: a Prospective, Multicenter, Randomized, Parallel-Controlled Clinical Trial in China
- The Role of the NLR and PLR in Urinary Tract Infection
- Threat of Antimicrobial Resistance among Pilgrims with Infectious Diseases during Hajj: Lessons Learnt from COVID-19 Pandemic
- Leclercia adecarboxylata urinary tract infection in a patient with bladder cancer and recurrent hematuria
- A Case Series of Staphylococcus lugdunensis Infection in Cancer Patients at an Academic Cancer Institute in the United States
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.