Aeromonas hydrophila sepsis after ERCP and laparoscopic cholecystectomy: a case report

Endoscopic retrograde cholangiopancreatography is crucial for treating pancreaticobiliary diseases with biliary stones, but it can lead to serious complications, including severe systemic sepsis. Sepsis is a life-threatening critical condition. The 1 h bundle recommended by the Surviving Sepsis Campaign remains the core strategy for early management. Although the 2021 and 2026 Surviving Sepsis Campaign guidelines have adopted a stratified approach to antibiotic timing in non-shock patients, personalized early intervention is crucial for high-risk critically ill individuals. We present a 76-year-old female with cholecystolithiasis complicated by choledocholithiasis who developed Aeromonas hydrophila sepsis following Endoscopic Retrograde Cholangiopancreatography stone extraction and laparoscopic cholecystectomy. Within a span of 10 h, the patient's white blood cell count experienced a significant decline, accompanied by increased levels of inflammatory biomarkers and a Sequential Organ Failure Assessment score of 2. The 1 h sepsis bundle was promptly implemented, including blood culture, lactate measurement, intravenous fluid resuscitation, and empirical meropenem. Blood culture identified Aeromonas hydrophila infection, and targeted antimicrobial therapy was administered. The patient achieved favorable recovery with no recurrence at 2-month follow-up. To our knowledge, this is the first reported case of Aeromonas hydrophila sepsis after combined endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy. Personalized 1 h bundle implementation is vital to optimize prognosis in high-risk patients. This case also highlights the importance of strict adherence to endoscope reprocessing protocols, routine quality monitoring, and water quality management to minimize procedure-related infection risks.