The mortality rate of severe sepsis with or without shock in the intensive care setting is very high (about 23%)[
6], and evidence-based recommendations have been published with the aim of improving the outcomes of severe sepsis and septic shock in critically ill patients[
4,
7]. Severe sepsis and septic shock are associated with significantly higher mortality in cirrhotic patients than in non-cirrhotic patients[
8]. The most common bacterial infections seen in cirrhotic patients are spontaneous bacterial peritonitis (25 to 31%), urinary tract infections (20 to 25%), pneumonia (15 to 21%), bacteremia (12%), and soft tissue infections (11%), and the most common causative organisms of such infections are
Staphylococcus species,
Enterococcus species, and methicillin-resistant
Staphylococcus aureus among Gram-positive bacteria and
Escherichia coli,
Klebsiella species, and
Enterobacter species among Gram-negative bacteria. Other bacterial infections such as those involving
Vibrio species,
Aeromonas species,
Clostridium species, and
Mycobacterium tuberculosis are more virulent[
3,
9].
Aeromonas species cause a variety of diseases including acute gastroenteritis, skin and soft tissue infections, and septicemia.
Aeromonas septicemia is strongly associated with immunosuppressive conditions such as cirrhosis and hematological malignancies. Among the various
Aeromonas species,
A. hydrophila is the most commonly identified pathogen[
1,
2,
10]. Bacterial translocation is associated with the pathogenesis of spontaneous bacterial peritonitis and spontaneous bacteremia in cirrhotic patients. In the present case, as the patient had no trauma episodes or wound site, oral transmission was the probable cause of infection pathway. The intravenous administration of carbapenems or third generation cephalosporins combined with aminoglycosides or fluoroquinolones is recommended as an empiric treatment for serious bacterial infections in cirrhotic patients[
3]. In the present case, the early recognition of septic shock and the initiation of rapid resuscitation techniques including the administration of antimicrobials were considered to be the most important factors in the saving of our patient’s life. It is reported that delaying antibiotic treatment until after the identification of shock is associated with a worse prognosis[
11]. Various kinds of treatment have been used to treat severe sepsis and septic shock. For instance, direct hemoperfusion with PMX is suggested to have favorable effects on blood pressure, oxygenation, and mortality[
12], and hemoperfusion using PMMA membrane hemofilters, which have an enhanced ability to absorb cytokines, might improve the mortality rate of such conditions[
13]. In addition, the early infusion of stress dose steroids should be considered in patients with septic shock whose blood pressure issues are poorly responsive to fluid resuscitation and catecholamine[
7], and the administration of rhTM might be effective at treating sepsis-induced coagulopathy[
14]. Although further investigations are required to confirm whether such supportive therapies are effective, aggressive treatment with multiple modalities and combined therapies could be effective in patients with severe septic shock who are unresponsive to conventional management strategies.