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Publisher: Peytchinski Publishing Ltd.
ISSN: 1312-773X (Online)
Issue: 2026, vol. 32, issue3
Subject Area: Medicine
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DOI: 10.5272/jimab.2026323.7103
Published online: 21 September 2026
Case report
J of IMAB. 2026 Jul-Sep;32(3):7103-7107
A FATAL HEALTHCARE-ASSOCIATED INFECTION FOLLOWING SPINAL SURGERY CAUSED BY MULTIDRUG-RESISTANT PATHOGENS: A CASE REPORT
Anna Kircheva1
, Magdalena Konstantinova2, Eliyana Ivanova3
, Desislava Vankova4,
1) Department of Clinical Epidemiology, MHAT "St. Anna - Varna ", Varna, Bulgaria.
2) Department Clinic of anaesthesiology and intensive care, UMPHAT “ St. Marina”, Varna, Bulgaria.
3) Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna, Bulgaria.
4) Department of Social Medicine and Healthcare Organisation, Faculty of Public Health, Medical University of Varna, Bulgaria.
ABSTRACT:
Background: Healthcare-associated infections (HAIs) caused by multi-drug-resistant (MDR) bacteria represent a major public health challenge, particularly among surgical and critically ill patients. Surgical site infections in neurosurgical practice are frequently associated with prolonged hospitalization, repeated invasive procedures and exposure to hospital environments where MDR pathogens may persist and spread.
This case report aims to illustrate the clinical course and fatal outcome of a HAIs following spinal surgery, caused by highly resistant bacterial pathogens.
Methods: We report the case of a 67-year-old male patient who developed a postoperative spinal surgical site infection caused initially by methicillin-resistant coagulase-negative staphylococci (CNS-MR) and subsequently by multidrug-resistant Klebsiella pneumoniae. Clinical data, imaging findings, microbiological results and therapeutic interventions were retrospectively analyzed. Epidemiological investigations were conducted to assess potential sources and routes of pathogen transmission within the hospital environment.
Results: Despite multiple surgical revisions and targeted antimicrobial therapy guided by susceptibility testing, the infection progressed to systemic inflammatory response and multiorgan failure. The patient had several predisposing risk factors, including advanced age, undiagnosed and uncontrolled type 2 diabetes mellitus, prolonged hospitalization, and repeated high-risk surgical interventions (ASA class III). Identical MDR bacterial strains were detected in the operating room, intensive care units environment, nasal carriage among healthcare workers, indicating ongoing cross-transmission within the clinical setting.
Conclusions: This case highlights the devastating consequences of HAIs caused by MDR pathogens in high-risk inpatient groups. It underscores the critical importance of strict infection prevention and control (IPC) measures, continuous surveillance of antimicrobial resistance and early identification of vulnerable patients to reduce the risk of severe and fatal outcomes. Within a One Health perspective, the professional sharing of single case reports from local clinical settings plays a meaningful role in strengthening IPC practices worldwide.
Keywords: healthcare-associated infection, multidrug resistant bacteria, antibiotic use among inpatients, antimicrobial resistance, infection prevention and control (IPC), case report, One Health,
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Please cite this article as: Kircheva A, Konstantinova M, Ivanova E, Vankova D. A Fatal Healthcare-Associated Infection Following Spinal Surgery Caused by Multidrug-Resistant Pathogens: A Case Report. J of IMAB. 2026 Jul-Sep;32(3):7103-7107. [Crossref - 10.5272/jimab.2026323.7103]
Correspondence to: Eliyana Ivanova, Department of Hygiene and Epidemiology, Faculty of Public Health, Medical University of Varna; 55, Marin Drinov Str., Varna 9002, Bulgaria. E-mail: eliyana.ivanova@mu-varna.bg
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Received: 19 May 2026
Published online: 21 September 2026