SHM Converge Scientific Abstract ePoster Gallery-Klebsiella Bacteremia Following Radial-Access Pci: An Uncommon Infectious Complication

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This case report describes an uncommon infectious complication after percutaneous coronary intervention (PCI). A 79-year-old man with hypertension, type II diabetes, and severe distal LAD stenosis was admitted after a fall with myocardial infarction and rhabdomyolysis. He was treated in the ICU and underwent PCI via right radial access without immediate procedural problems.<br /><br />About 60 hours later, he developed abrupt fever, worsening confusion, chills, and diffuse extremity rigidity. Initial evaluation did not reveal another source of infection: chest X-ray, urinalysis, and liver function tests were unremarkable, and his leukocyte count remained normal. Blood cultures later grew Klebsiella species, and ceftriaxone was started. By 72 hours post-procedure, he developed significant swelling and tenderness of the right arm from axilla to wrist, which was felt to be the likely source of bacteremia, consistent with access-site phlebitis. His fever and confusion resolved after antibiotics, the arm inflammation improved, and he was clinically stable and afebrile by post-procedure day 6. He was discharged on a seven-day course of levofloxacin.<br /><br />The report emphasizes that although PCI is generally considered low risk for infection, bacteremia can occur and may present with fever and altered mental status even when the white blood cell count is normal. Risk factors include advanced age, heart failure, repeated vascular access, prolonged sheath dwell time, and poor local site hygiene. Prior studies have shown that positive blood cultures can occur after PCI, though often without symptoms. The authors highlight that radial access does not eliminate infectious risk and that early recognition of access-site infection is important to prevent progression to sepsis.

Asset Subtitle

Lindsay Wilson

Meta Tag

Author List Lindsay Wilson, Michael Iannetti

Category Clinical Vignettes

Concept Percutaneous Coronary Intervention

Concept Sepsis

Concept Bacteremia

Concept Infection

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization West Virginia University School of Medicine - Charleston Division

Presenting Author Lindsay Wilson

Track Adult

Keywords

percutaneous coronary intervention

PCI

Klebsiella bacteremia

radial access

access-site phlebitis

myocardial infarction

altered mental status

fever

diabetes mellitus

sepsis risk

Percutaneous Coronary Intervention

Sepsis

Bacteremia

Infection

Blood Culture