Jiaying Lu, Yingying Xia, Han Wang, Chen Gao, Xingguo Niu, Yibo Zhang, Dalong Zhang
For complex mixed infections following liver retransplantation, continuous evaluation of pathogen profiles, immune status, and organ function is critical for guiding individualized treatment strategies. This case highlights that, while potent targeted anti-infective therapy may be life-saving, close monitoring and prompt intervention for treatment-related adverse events and complications are equally essential to achieve a balance between therapeutic benefit and clinical risk under critical conditions.
BACKGROUND: Patients undergoing liver retransplantation remain in a prolonged immunosuppressed state and are at high risk for complex mixed infections caused by multidrug-resistant organisms (MDROs) and invasive fungi. Under such circumstances, accurately identifying the predominant pathogens and developing a treatment strategy that balances anti-infective therapy with organ function preservation remain major challenges in current clinical practice.
CASE PRESENTATION: This article reports the case of a 59-year-old male patient who developed severe pneumonia, septic shock, and multiple organ failure following liver retransplantation. Etiological investigations identified carbapenem-resistant Klebsiella pneumoniae (CRKP) harboring NDM+/KPC+, carbapenem-resistant Acinetobacter baumannii (CRAB) carrying OXA-23+, along with co-infections caused by Aspergillus fumigatus, Aspergillus flavus, and Candida albicans. Targeted anti-infective therapy was initiated promptly, including aztreonam/avibactam, polymyxins, eravacycline, isavuconazole, and caspofungin during the treatment course. During anti-infective therapy, the patient developed severe bone marrow suppression and gastrointestinal bleeding secondary to coagulation dysfunction. Following tailored modification of the antimicrobial regimen and aggressive supportive management with blood product transfusions, the infection was effectively controlled, and the patient was successfully weaned from mechanical ventilation and discharged after recovery.
CONCLUSIONS: For complex mixed infections following liver retransplantation, continuous evaluation of pathogen profiles, immune status, and organ function is critical for guiding individualized treatment strategies. This case highlights that, while potent targeted anti-infective therapy may be life-saving, close monitoring and prompt intervention for treatment-related adverse events and complications are equally essential to achieve a balance between therapeutic benefit and clinical risk under critical conditions.