Late polymicrobial transjugular intrahepatic portosystemic shunt infection in a liver transplant patient: A case report

Table 1 Mortality rates associated with monomicrobial and polymicrobial endotipsitis

Microbial agent	Reported cases	Mortality rate, %
Enterococcus (faecalis, faecium)	14	21
Staphylococcus (aureus, epidermidis)	9	44
Escherichia coli	7	43
Candida (glabrata, albicans)	7	57
Lactobacillus (rhamnosus, acidophilus)	3	67
Streptococcus (sanguis, bovis)	2	0
Gemella morbillorum	2	0
Klebsiella (pneumonia, oxytoca)	3	33
Serratia marcescens	1	0
Enterobacter cloacae	1	0
Salmonella typhi	1	0
polymicrobial infection	9	50
total	59	39

Adapted from Alberto Garcia-Zamalloa.

Table 2 Polymicrobial cases of endotipsitis

Case and microbial agent	Treatment course	Outcome	Ref.
Case 1: Gram-positive and negative bacteria, and fungus	Antibiotic × 2 wk->antifungal × 2 ws->antibiotics->liver transplant	Resolved	[2]
Case 2: Gram-negative bacteria	antibiotics × 6 wk->antibiotics -> liver transplant	Resolved	[4]
Case 3: Gram-negative bacteria	antibiotic × 4 wk	Resolved	[20]
Case 4: Gram-negative bacteria and fungus	antibiotics and antifungal × 6 wk-> antifungal indefinitely	Resolved	[20]
Case 5: Gram-positive and negative bacteria	antibiotics->TIPS revision	Death	[21]
Case 6: Gram-positive and negative bacteria, and fungi	antibiotics->antibiotics, antifungal and TIPS revision-> antibiotic->antibiotics and TIPS revision->oral antibiotics indefinitely	Unknown	[22]
Case 7: Gram-positive and negative bacteria, and fungus	antibiotics and antifungals->liver transplant	Resolved	[23]
Case 8: Gram-positive and negative bacteria	antimicrobials × 4 wk ->liver transplantation	Resolved	[24]
Case 9: Gram-positive and negative bacteria, and fungi	antibiotics × 10 d-> TIPS thrombectomy & revision, and antibiotics × 6 wk-> TIPS thrombectomy and revision, and antibiotics and antifungals for 6 wk->balloon sweep of TIPS, antifungals indefinitely with antibiotics as tolerated	Death	Current case

TIPS: Transjugular intrahepatic portosystemic shunt.