Surgical Wound Infection Due to Sepsis in a Patient with Chronic Kidney Disease: A Case Report

Abstract

Background: Chronic Kidney Disease (CKD) is a progressive condition that causes a gradual Background: Chronic Kidney Disease (CKD) is a progressive condition that causes gradual decline in kidney function and increases patient susceptibility to infection. One of the serious complications that can occur in CKD patients is sepsis, especially if there is an untreated infection, such as a surgical wound infection. The combination of CKD and sepsis worsens the prognosis and requires comprehensive and multidisciplinary management. Aim: The study aims to examine patients who have chronic kidney disease and have a surgical wound infection caused by Sepsis Et Causa. Case Report: A 62-year-old female patient came to the Emergency Department of CAM Hospital, Bekasi, with complaints of a surgical wound seeping since ± 1 hour before hospitalisation. The wound was initially swollen for 5 months before hospitalisation, and fluid came out of the swelling. Nausea (+), vomiting (-), defecation dbn. For the past few months, the patient complained of persistent fatigue, decreased appetite, and discomfort in the stomach. In addition, the patient's urination frequency increased at night, discolouration (-), blood (+), foam (+). ICU management focuses on fluid resuscitation to improve tissue perfusion, broad-spectrum antibiotics to treat surgical site infections, and organ support, including cardiovascular stabilisation with vasopressors if needed, renal management with close monitoring of fluids and electrolytes, and respiratory support with mechanical ventilation. The prognosis of this patient is affected by the combination of severe sepsis and CKD 4a, which increases the risk of mortality without aggressive therapy. Conclusion: Based on the analysis, patients with a diagnosis of CKD 4a and Sepsis et causa surgical wound infection require intensive care in the ICU due to clinical conditions that show signs of multi-organ dysfunction due to severe sepsis. Wound infection in the surgical wound that developed into a right psoas abscess became the main source of infection that contributed to the occurrence of sepsis, exacerbated by the underlying condition of CKD 4a. Decreased kidney function (eGFR 21 mL/minute/1.73 m²), increased creatinine, metabolic acidosis, and anaemia due to CKD worsen the body's ability to fight infection. Clinically, the patient showed symptoms of hypotension, tachycardia, low oxygen saturation, and leukocytosis, which were supported by qSOFA scores of 2 and SOFA 5, confirming the presence of a systemic inflammatory response with dysfunction in the respiratory, cardiovascular, and renal systems. Based on the analysis, patients with a diagnosis of CKD 4a and Sepsis et causa surgical wound infection require intensive care in the ICU due to clinical conditions that show signs of multi-organ dysfunction due to severe sepsis. The patient's prognosis depends on the speed and effectiveness of intervention, considering that sepsis in patients with comorbid CKD has a significant risk of mortality.