Asian Journal of Research in Nephrology

Aim: Pediatric patients with multiple congenital and chronic conditions are particularly vulnerable to critical illness as they are predisposed to severe infections and multi-organ dysfunction. This case report details the clinical course of a 13-year-old female with a complex medical history who developed life-threatening nosocomial infections leading to a fatal outcome.

Presentation of Case: The patient, with a history of mitochondrial disorder, microcephaly, neurodevelopmental delay, cerebral palsy, left eye evisceration, epilepsy, type 1 diabetes mellitus, and chronic respiratory failure requiring long-term mechanical ventilation, was admitted emergently to the Intensive Care Unit (ICU). On admission, the patient had a Glasgow Coma Scale of 3/15 presented with fever, purulent secretions and multiple skin lesions along with signs of systemic infection. Microbiological cultures revealed Burkholderia cepacia complex and Candida species in tracheostomy secretions, significant pyuria suggestive of urinary tract infection, and evidence of central line-associated bloodstream infection (CLABSI) as well as a PEG tube infection. This presentation was likely to be consistent with a mitochondrial disorder-related multi-organ dysfunction syndrome.

Discussion: This case highlights the combined effects on pediatric patients of invasive  procedures, chronic comorbidities, and antibiotic resistance. Frequent isolation of Klebsiella that produce ESBLs highlighted to the challenges in antibiotic selection and contributed to the fatal outcome.

Conclusion: This case underscores the challenges inherent in managing critically ill pediatric patients with complex congenital disorders. The interplay of multiple comorbidities, invasive procedures, and nosocomial infections can lead to a rapid decline in clinical status. Enhanced infection control measures and individualized management strategies are critical for improving outcomes in this vulnerable population.