{"id":8907,"date":"2024-09-13T04:35:59","date_gmt":"2024-09-13T04:35:59","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=8907"},"modified":"2025-04-09T10:25:32","modified_gmt":"2025-04-09T10:25:32","slug":"a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/","title":{"rendered":"A Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus."},"content":{"rendered":"

[vc_row][vc_column][vc_column_text]<\/p>\n

Patient presentation<\/strong><\/h2>\n

A 70-year-old male, presented to the ER with a history of fever, neck pain, and generalized\u00a0tiredness. He has a known history of diabetes mellitus and no known drug allergies\u00a0(NKDA). Upon examination, he was conscious, oriented, and febrile with a temperature\u00a0of 100.2\u00b0F. His vitals were stable, with a pulse rate of 100\/min, blood pressure of 130\/70\u00a0mmHg, and oxygen saturation of 98% in room air. His capillary blood glucose was\u00a0elevated at 434 mg\/dl. Respiratory and cardiovascular examinations were unremarkable,\u00a0with bilateral air entry and normal heart sounds (S1, S2). The abdomen was soft with\u00a0bowel sounds present, and his neurological status showed minimal neck rigidity with no\u00a0focal deficits.<\/p>\n

Recent Medical History and Admission:<\/strong><\/h2>\n

A 70-year-old male with a recent history of treatment for right superior orbital tissue\u00a0syndrome (Tolosa-Hunt Syndrome) and cranial nerve palsy involving the right 2nd, 3rd, 4th,\u00a0and 6th cranial nerves, presented with generalized malaise, fatigue, and an inability to\u00a0walk. He also has a history of Type II diabetes mellitus and was under steroid treatment.\u00a0On 12\/08\/2024, he was admitted to the ICU with high-grade fever. On examination, he\u00a0exhibited neck rigidity and swelling in the left hand.<\/p>\n

Initial Investigations and Treatment:<\/strong><\/h2>\n

The patient was started on IV antibiotics, including Inj. Meropenem, Inj. Vancomycin, and Inj. Acyclovir. Blood investigations revealed elevated white blood cell count (WBC:\u00a037320), elevated C-reactive protein (CRP: 311), and arterial blood gas (ABG) showed\u00a0elevated lactate (3.8), indicative of sepsis. Urine routine analysis showed pus cells (8-10)\u00a0and nitrite positivity. A CT chest scan revealed no significant abnormalities except for\u00a0dependent changes, with no thoracic source of infection. Incidental findings of soft\u00a0tissue density lesions with mild surrounding inflammation in the right supraclavicular\u00a0region raised the possibility of lymphadenopathy, prompting a recommendation for a\u00a0focused ultrasound (USG) correlation.<\/p>\n

Imaging and Further Investigations:<\/strong><\/h2>\n

A CT abdomen showed bilateral perinephric fat stranding, suggesting pyelonephritis, along with left renal cortical cysts, and no ascites or other solid organ or bowel\u00a0abnormalities. Given the redness and localized swelling in the left dorsum of the hand,\u00a0the plastic surgery team recommended a venous Doppler of the left hand, which\u00a0revealed cephalic vein thrombosis up to the mid-forearm and complete thrombosis of\u00a0the basilic vein. No deep vein thrombosis was observed in the right upper limb. A USG of\u00a0the right hand showed tenosynovitis of the flexor digitorum superficialis of the third finger,\u00a0with diffuse inflammatory changes involving the mid-palmar space, though no definable\u00a0collection was noted. The patient underwent an incision and drainage procedure for the\u00a0left-hand abscess.<\/p>\n

Neurological Findings:<\/strong><\/h2>\n

MRI brain with contrast showed age-related changes, including thin, diffuse\u00a0periventricular and patchy subcortical white matter ischemic changes, along with mild\u00a0pachymeningeal enhancement. These findings suggested possible infection or post-dural puncture with intracranial hypotension. An MR angiogram showed no evidence of stenosis or occlusion. MRI orbit findings (reports enclosed) were also evaluated. A\u00a0neurologist diagnosed subacute meningitis, leading to the cessation of Acyclovir, and antibiotics were adjusted to Inj. Flucloxacillin after consultation with infectious disease\u00a0and critical care specialists for MSSA sepsis.<\/p>\n

Cardiovascular Assessment:<\/strong><\/h2>\n

A cardiologist was consulted, and the patient underwent a transesophageal\u00a0echocardiogram (TEE) under IV sedation. No vegetations were observed. Dermatological\u00a0consultation was obtained for redness and swelling in the hand, and treatment advice\u00a0was followed. Ophthalmology consultation ruled out papilledema.<\/p>\n

Rising WBC Count and PET-CT:<\/strong><\/h2>\n

Although the WBC count initially showed a reducing trend, it began to rise again, leading\u00a0to a PET-CT scan. The PET-CT showed a heterogeneous collection with air pockets in the\u00a0prevertebral region and low-grade metabolic activity in the cervical spine (C4 level),\u00a0paravertebral, and posterior perivertebral regions. A similar collection was seen in the\u00a0right pelvis, extending into the right thigh. The findings suggested abscess formation, and\u00a0further microbiological correlation was recommended.<\/p>\n

\"\"<\/p>\n

\"\"<\/p>\n

Surgery and Postoperative Care:<\/strong><\/h2>\n

Following a multidisciplinary team review, including critical care, spinal surgery, and\u00a0plastic surgery teams, the decision was made to proceed with surgery. The patient\u00a0underwent successful surgery after receiving anesthetist and cardiology clearance. He\u00a0tolerated the procedure well, with 2 units of PRBC transfusion administered\u00a0intraoperatively. On the third postoperative day (POD), he was transferred to the ward,\u00a0where follow-up blood tests showed decreasing trends in inflammatory markers. Despite\u00a0a gradual rise in WBC and CRP levels, further blood cultures showed no bacterial growth.<\/p>\n

Surgical details:<\/strong><\/h2>\n

A series of five different complex and successful surgical interventions were carried out to expertly manage the patient’s severe abscesses and spinal complications. The left forearm was meticulously explored and debrided, with necrotic tissue excised and a drain strategically placed to ensure optimal recovery. A challenging cervical corpectomy of C5 and C6 was performed with precision, removing the diseased disc and securing a Globus expandable cage and cervical plate, all while maintaining structural integrity and reducing infection risk. The palmar abscess in the right hand was expertly drained, ensuring preservation of the flexor tendon sheath through careful decompression. The right thigh abscess was skillfully incised and drained, removing 200 ml of pus and placing a drain to promote healing. In a remarkable display of surgical proficiency, the cervical plate was revised due to bone resorption and cage migration, with the placement of a larger, more secure plate and screws, ensuring structural stability and long-term success. Each procedure demonstrated a high level of expertise, contributing to the patient\u2019s recovery and stability.<\/p>\n

Postoperative Imaging:<\/strong><\/h2>\n

A CT cervical spine scan showed an anterior spinal fixation device at the C4-C7 level, with\u00a0residual prevertebral, paravertebral, and epidural collections. A CT abdomen revealed\u00a0bilateral renal cortical cysts and minimal perinephric fat stranding. A CT scan of the right\u00a0thigh showed a reduction in the size of the abscess compared to a previous MRI, though\u00a0further assessment with USG or MRI was recommended. Repeat blood cultures revealed\u00a0gram-positive cocci and Enterococcus, for which Inj. Teicoplanin was initiated.<\/p>\n

Antibiotic Therapy and Discharge:<\/strong><\/h2>\n

The patient was started on a regimen of Inj. Ceftazidime-Avibactam-Aztreonam for MDR\u00a0Klebsiella and continued for 5 days. Pus cultures revealed Staphylococcus aureus,\u00a0prompting continuation of flucloxacillin. His vital signs, electrolytes, and inflammatory\u00a0markers were closely monitored. With improving clinical signs and reduced inflammatory\u00a0markers, the patient\u2019s condition stabilized. The infectious disease specialist\u00a0recommended completing a course of Inj. Ampicillin for 12 days, Cefazolin for 4 weeks,\u00a0and Ceftazidime-Avibactam for an additional 2 days.<\/p>\n

Discharge Plan:<\/strong><\/h2>\n

The patient showed significant clinical improvement, with reduced fever, tachycardia,\u00a0and no evidence of further complications. The drainage tube and catheter were removed, and the patient was discharged with a follow-up plan and specific discharge medications\u00a0including continuing IV Antibiotic course covering Staphylococcus aureus, Enterococcus\u00a0fecalis, MDR Klebsilla organisms.<\/p>\n

Review:<\/strong><\/h2>\n

The patient came at 1 week review, performing well, tolerating the IV Antibiotics with\u00a0decreasing WBC trend, getting regular physiotherapy and other supportive care, advised\u00a0to continue and complete the course of IV Antibiotics.<\/p>\n

FINAL DIAGNOSIS:<\/strong><\/h2>\n

– METHICILLIN SENSITIVE STAPHYLOCOCCUS AUREUS SEPSIS\u2014[CERVICAL – EPIDURAL ABSCESS C4 TO C6, MULTIPLE LEVEL OSTEOMYELITIS WITH BONE EROSION, MULTIPLE SOFT TISSUE WOUND INFECTION (S. AUREUS), RIGHT THIGH ABSCESS, RIGHT HAND PALMAR ABSCESS, LEFT FOREARM INFECTED THROMBOPHLEBITIS, BILATERAL PYELONEPHRITIS]<\/p>\n

– ENTEROCOLLUS FECALIS \u2013 BACTEREMIA<\/p>\n

– MDR – KLESIELLA PNEUMONIA – UROSEPSIS<\/p>\n

– TYPE II DIABETES MELLITUS<\/p>\n

– SYSTEMIC HYPERTENSION<\/p>\n

– DYSLIPIDEMIA<\/p>\n

PROCEDURE DONE:<\/strong><\/h2>\n

– S\/P EXPLORATION AND DEBRIDEMENT LEFT FOREARM ABSCESS<\/p>\n

– S\/P ACCF C5 AND C6 CORPECTOMY<\/p>\n

– S\/P RIGHT THIGH ABSCESS INCISION AND DRAINAGE<\/p>\n

– S\/P RIGHT PALMAR ABSCESS – EXPLORATION AND DRAINAGE OF ABSCESS<\/p>\n

– S\/P TRANSESOPHAGEAL ECHOCARDIOGRAM<\/p>\n

– S\/P RE-EXPLORATION AND CERVICAL PLATING<\/p>\n

Brief about management of Staphylococcus aureus Bactremia<\/strong><\/h2>\n

Effective management of **Staphylococcus aureus** infections requires immediate\u00a0source control, such as removing indwelling devices and surgically draining abscesses, along with antimicrobial therapy tailored to the strain’s susceptibility and affected\u00a0organs. Device removal is crucial, especially for coagulase-negative staphylococci\u00a0(CoNS) due to biofilm formation. For patients with bacteremia, central venous catheters\u00a0should be removed if bacteremia persists for over 72 hours. Antibiotic therapy duration\u00a0varies, with at least 2 weeks for uncomplicated cases and 4 weeks or more for\u00a0complicated ones.<\/p>\n

Empirical therapy- When a staphylococcal infection is suspected in critically ill patients,\u00a0empiric therapy targeting methicillin-resistant S. aureus (MRSA) is essential, especially\u00a0in cases of septicemia, prior MRSA infection, known MRSA colonization, or risk factors\u00a0like recent hospitalization, surgery, hemodialysis, and HIV infection. Proximity to\u00a0indwelling medical devices also warrants MRSA coverage. Vancomycin is recommended\u00a0for empiric treatment of coagulase-negative staphylococci (CoNS) due to high methicillin\u00a0resistance. Patients should be monitored for clinical response and microbiologic results, with therapy tailored to pathogen susceptibility. If no improvement is seen within 72\u00a0hours, further evaluation for complications or resistant organisms is necessary.<\/p>\n

For the treatment of MSSA bacteremia, first-generation cephalosporins like cefazolin and\u00a0semisynthetic antistaphylococcal penicillins like cloxacillin are optimal. Vancomycin,\u00a0though bactericidal, is less effective than beta-lactams unless there is a severe beta-lactam allergy. MRSA is defined by an oxacillin MIC of \u22654 \u03bcg\/mL and is resistant to all beta-lactam antibiotics. Invasive MRSA infections should be treated with vancomycin, teicoplanin, or daptomycin. If specialized resistance testing is unavailable, methicillin\u00a0resistance should be assumed.<\/p>\n

Duration of therapy depends of the site of infection. For example, Bacteremia needs four\u00a0to six weeks of therapy from the date of first negative blood culture, Osteomyelitis needs\u00a0six weeks of therapy, Infective Endocarditis needs 2 weeks of therapy<\/p>\n

\"\"<\/strong><\/h2>\n

\"\"<\/strong><\/h2>\n

Reference<\/strong><\/h2>\n

https:\/\/www.researchgate.net\/figure\/Figure-Proposed-flow-diagram-for-<\/p>\n

Staphylococcus-aureus-bacteremia-management-May-differ_fig1_364082368<\/p>\n

Harrison Textbook of internal medicine<\/p>\n

https:\/\/www.uptodate.com\/contents\/clinical-approach-to-staphylococcus-aureus-bacteremia-in-adults<\/p>\n

https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK441868\/<\/p>\n

\"\"Dr. Vignesh. A. S<\/strong>
\nDNB General Medicine Resident<\/em>
\nKauvery Hospital, Chennai<\/p>\n

 <\/p>\n

 <\/p>\n

\"\"Dr. Jayaraman K<\/strong>
\nSenior Consultant Internal Medicine specialist and Diabetologist<\/em>
\nKauvery Hospital, Chennai<\/p>\n

 <\/p>\n

 <\/p>\n

\"\"Dr. Sridhar N<\/strong>
\nConsultant Intensivist<\/em>
\nKauvery Hospital, Chennai<\/p>\n

 <\/p>\n

 <\/p>\n

\"\"Dr. Balamurali G<\/strong>
\nSenior Consultant<\/em>
\nKauvery Hospital, Chennai<\/p>\n

 <\/p>\n

 <\/p>\n

\"Dr.Dr. Sathish Manivel\u00a0<\/strong>
\nConsultant Plastic and Aesthetic Surgeon<\/em>
\nKauvery Hospital, Chennai<\/p>\n

 <\/p>\n

 <\/p>\n

\"\"Dr. Vijayalakshmi Balakrishnan\u00a0<\/strong>
\nSenior Consultant, Infectious Diseases<\/em>
\nKauvery Hospital, Chennai<\/p>\n

 <\/p>\n

 <\/p>\n

And Many more, from the Anesthetist, Staffs who were involved in this case[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n","protected":false},"excerpt":{"rendered":"

[vc_row][vc_column][vc_column_text] Patient presentation A 70-year-old male, presented to the ER with a history of fever, neck pain, and generalized\u00a0tiredness. He has a known history of diabetes mellitus and no known<\/p>\n","protected":false},"author":2,"featured_media":8908,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[79],"tags":[],"class_list":["post-8907","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-ima-journal-september-2024"],"yoast_head":"\nA Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus.<\/title>\n<meta name=\"description\" content=\"A 70-year-old male, presented to the ER with a history of fever, neck pain, and generalized tiredness.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus.\" \/>\n<meta property=\"og:description\" content=\"A 70-year-old male, presented to the ER with a history of fever, neck pain, and generalized tiredness.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/\" \/>\n<meta property=\"og:site_name\" content=\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\" \/>\n<meta property=\"article:published_time\" content=\"2024-09-13T04:35:59+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2025-04-09T10:25:32+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2024\/09\/background-banner-sep-24-5.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"1308\" \/>\n\t<meta property=\"og:image:height\" content=\"545\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"kh-ima-admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"kh-ima-admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"10 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/\",\"name\":\"A Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus.\",\"isPartOf\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2024\/09\/background-banner-sep-24-5.jpg\",\"datePublished\":\"2024-09-13T04:35:59+00:00\",\"dateModified\":\"2025-04-09T10:25:32+00:00\",\"author\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb\"},\"description\":\"A 70-year-old male, presented to the ER with a history of fever, neck pain, and generalized tiredness.\",\"breadcrumb\":{\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#primaryimage\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2024\/09\/background-banner-sep-24-5.jpg\",\"contentUrl\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2024\/09\/background-banner-sep-24-5.jpg\",\"width\":1308,\"height\":545},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"A Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus.\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#website\",\"url\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/\",\"name\":\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\",\"description\":\"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Person\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb\",\"name\":\"kh-ima-admin\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/image\/\",\"url\":\"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g\",\"contentUrl\":\"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g\",\"caption\":\"kh-ima-admin\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"A Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus.","description":"A 70-year-old male, presented to the ER with a history of fever, neck pain, and generalized tiredness.","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/","og_locale":"en_US","og_type":"article","og_title":"A Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus.","og_description":"A 70-year-old male, presented to the ER with a history of fever, neck pain, and generalized tiredness.","og_url":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/","og_site_name":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","article_published_time":"2024-09-13T04:35:59+00:00","article_modified_time":"2025-04-09T10:25:32+00:00","og_image":[{"width":1308,"height":545,"url":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2024\/09\/background-banner-sep-24-5.jpg","type":"image\/jpeg"}],"author":"kh-ima-admin","twitter_card":"summary_large_image","twitter_misc":{"Written by":"kh-ima-admin","Est. reading time":"10 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"WebPage","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/","name":"A Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus.","isPartOf":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#website"},"primaryImageOfPage":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#primaryimage"},"image":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#primaryimage"},"thumbnailUrl":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2024\/09\/background-banner-sep-24-5.jpg","datePublished":"2024-09-13T04:35:59+00:00","dateModified":"2025-04-09T10:25:32+00:00","author":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb"},"description":"A 70-year-old male, presented to the ER with a history of fever, neck pain, and generalized tiredness.","breadcrumb":{"@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#primaryimage","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2024\/09\/background-banner-sep-24-5.jpg","contentUrl":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-content\/uploads\/2024\/09\/background-banner-sep-24-5.jpg","width":1308,"height":545},{"@type":"BreadcrumbList","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-september-2024\/a-battle-on-multiple-fronts-managing-severe-infections-and-surgical-challenges-in-a-diabetic-patient-deadly-staph-along-with-mdr-klebsiella-and-enterococcus\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/www.kauveryhospital.com\/ima-journal\/"},{"@type":"ListItem","position":2,"name":"A Battle on Multiple Fronts: Managing Severe Infections and Surgical Challenges in a Diabetic Patient- Deadly Staph along with MDR Klebsiella and Enterococcus."}]},{"@type":"WebSite","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#website","url":"https:\/\/www.kauveryhospital.com\/ima-journal\/","name":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","description":"Kauvery Hospital | Patient Newsletters | A Monthly Newsletter from your Partners in Good Health","potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/www.kauveryhospital.com\/ima-journal\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Person","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/a008aa764057e74557d708f2381a5acb","name":"kh-ima-admin","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/www.kauveryhospital.com\/ima-journal\/#\/schema\/person\/image\/","url":"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/6b190d48867033f0c3c0aac5530295535596218654f543741508cab11520ab8f?s=96&d=mm&r=g","caption":"kh-ima-admin"}}]}},"_links":{"self":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/8907","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/comments?post=8907"}],"version-history":[{"count":15,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/8907\/revisions"}],"predecessor-version":[{"id":9041,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/posts\/8907\/revisions\/9041"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/media\/8908"}],"wp:attachment":[{"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/media?parent=8907"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/categories?post=8907"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.kauveryhospital.com\/ima-journal\/wp-json\/wp\/v2\/tags?post=8907"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}