Persistent bacteraemia caused by Staphylococcus aureus in the gall bladder.

Area of Science:

• Infectious Diseases
• Nephrology
• Critical Care Medicine

Background:

• Staphylococcus aureus bacteraemia (SAB) presents significant morbidity and mortality.
• Occult infection foci can lead to persistent SAB and treatment failure.
• Early identification of infection sites is crucial for effective management.

Observation:

• A unique case of a 65-year-old male on haemodialysis with end-stage renal disease developed septic shock from SAB.
• Despite 18 days of appropriate antibiotics, the patient exhibited persistent high-grade bacteraemia.
• Percutaneous drainage of the gallbladder led to the resolution of bacteraemia.

Findings:

• The gallbladder was identified as an occult nidus of Staphylococcus aureus infection.
• Gallbladder drainage was critical in eradicating persistent SAB.
• Prompt intervention targeting the occult source was essential for clinical improvement.

Implications:

• Clinicians should maintain a high index of suspicion for occult S. aureus infection sites, particularly in immunocompromised patients.
• Gallbladder pathology should be considered in cases of persistent or relapsing SAB.
• This case underscores the importance of source control in managing complex bacteraemia.