Management of Septic Shock Due to Community-Acquired Pneumonia with Chronic Kidney Disease: A Case Report Arief Kurniawan (a*), Nur Pudyastuti Pratiwi (b)
a) Department of Anesthesiology and Intensive Therapy
Faculty of Medicine Universitas Jenderal Achmad Yani
Cimahi, Indonesia
b) Department of Hospital Administration
Faculty of Medicine Universitas Jenderal Achmad Yani
Cimahi, Indonesia
Abstract
Community-acquired pneumonia is an infectious disease that can cause local and systemic inflammation that causes dysregulation of the body^s response and results in life-threatening organ dysfunction or commonly known as sepsis. Chronic kidney disease is a common and progressive disease that has become a public health problem. Infection is the leading cause of death in patients with end-stage renal disease and the cause of requiring hospitalization. Among infectious causes, pneumonia is one of the leading causes of infection and is associated with an increased risk of death with a poorer glomerular filtration rate.
A 49-year-old woman was diagnosed with uremic encephalopathy, chronic kidney disease with hyperkalemia, and community-acquired pneumonia. The choice of antibiotics was carried out by considering the risk of exposure to Pseudomonas bacteria including the presence of bronchiectasis, corticosteroid treatment >10 mg/day, broad-spectrum antibiotic treatment >7 days in the last month, and the presence of malnutrition. This patient was considered exposed to Pseudomonas bacteria. The antibiotics chosen for this patient were ceftazidime and levofloxacin as recommended by the following Indonesian Intensive Care Doctors Association. Successful management of cases of septic shock caused by community-acquired pneumonia is highly dependent on early diagnosis, optimal resuscitation, administration of antibiotics, and positive ventilation support when needed. Appropriate adjustment of drug dosage in patients with renal failure will result in optimal drug effects and lower side effects.
