SEPTIC SHOCK IN POLYTRAUMATIZED PATIENT: A CASE STUDY AND MANAGEMENT CHALLENGES

Abstract

Septic shock is a life-threatening condition that represents the final stage of sepsis, where infection leads to widespread systemic inflammation, tissue hypoperfusion and multi-organ dysfunction. The management of septic shock becomes even more complicated in polytraumatized patients, where multiple severe injuries often contribute to both the patient’s clinical deterioration and the risk of infection. We present the case of a 55-years-old male with multiple traumatic injuries including thoracic contusion, fractures of the cervical and rib bones and bilateral extremity fractures, who developed severe septic shock during his hospitalization. His medical history included type II diabetes mellitus and chronic gastritis.

Upon admission, the patient was intubated and mechanically ventilated, started on broad- spectrum antibiotics, anticoagulants and fluid resuscitation. Initial microbiological tests revealed no pathogens, but by day 10, Methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa and Acinetobacter species were identified. Despite aggressive antibiotic therapy, the patient developed worsening sepsis marked by hyperthermia, elevated inflammatory markers and oliguria by day 12. As his condition deteriorated, Cytosorb therapy was initiated on day 13, followed by hemodialysis on day 15 for acute kidney injury. On day 20, blood cultures revealed Vancomycin-resistant Enterococcus (VRE). As the infection evolved, additional pathogens including Klebsiella pneumoniae, Pseudomonas aeruginosa and Candida glabrata, were identified. Antifungal therapy with caspofungin was introduced on day 33. Despite the complexity of multiple infections and resistance patterns, the patient responded to tailored therapy, with negative blood cultures achieved by day 42.

This case highlights the challenges in managing septic shock in polytraumatized patients, particularly with the emergence of multidrug-resistant organisms. A multidisciplinary approach, involving timely microbiological testing, antibiotic stewardship and supportive therapies such as Cytosorb and renal replacement was essential for improving patient’s outcome. The case also underscores the importance of vigilant management of fungal infections such as Candida glabrata in critically ill, immunocompromised patients.