Recurrent Bloodstream Infections Without Sepsis in a Patient With Short Bowel Syndrome on Parenteral Nutrition: A Case of Potential Sepsis Tolerance

Adults with short bowel syndrome (SBS), malabsorption, and malnutrition often require long-term parenteral nutrition (PN), typically as total PN (TPN). These patients are susceptible to bloodstream infections and sepsis. We present a case of a 63-year-old male patient who developed SBS following an acute mesenteric event. During his follow-up, he experienced recurrent episodes of bacteremia and fungemia, likely due to non-adherence to infection prevention guidelines. Surprisingly, all but the final episode did not progress to sepsis. He recovered from these infections with fluid resuscitation and appropriate systemic antibiotics or antifungals and removal of the infected venous access when indicated. We hypothesize that this patient developed a state of tolerance to sepsis. The potential mechanisms that contribute to protection from sepsis in this patient with recurrent bloodstream infections are discussed.