E. tarda is not a colonizing flora of normal human intestines, and it is reported that it is only detected in 0.0073% of healthy human fecal samples[8]. E. tarda is a rare opportunistic pathogen in humans, mainly causing gastroenteritis [2], infectious subdural hematoma[9], bacteremia, epidural abscess wound infection [10], muscle necrosis, tissue abscess[7], meningitis, cholecystitis, endocarditis, osteomyelitis, soft tissue infections, and septicemia [11] in humans. Risk factors for E. tarda infection include exposure to the aquatic environment or contact with aquatic animals, such as amphibians or fish, eating habits (raw seafood), hepatobiliary underlying diseases, blood system tumors, etc. At present, there are few cases of E. tarda causing bloodstream infections. Once E. tarda enters the blood, the patient’s mortality rate is as high as 50% [12]. This paper is a case of septic shock caused by a blood infection of E. tarda, which deserves clinical attention. This patient has no history of exposure to the aquatic environment, but he had eaten sashimi before the onset, and then experienced symptoms of pain in the upper right abdomen with chills and fever. Therefore, this paper is considered that the patient’s consumption of infected raw sashimi was one of the factors in the biliary infection. The main drug resistance research of E. tarda is mainly colistin, such as polymyxin B and penicillin [13], which are sensitive to most Gram-negative antibiotics. The patient’s susceptibility results suggest sensitivity to most commonly used antibiotics, including carbapenems (ertapenem, imipenem, meropenem), cephalosporins (ceftazidime, ceftriaxone, cefoperazone, cefepime), β-lactamase inhibitors (cefoperazone sodium sulbactam sodium, aminoglycosides (amikacin, tobramycin), quinolones (levofloxacin, ciprofloxacin), tetracyclines (minocycline, doxycycline, tigecycline). The patient, in this case, has common bile duct stones with acute cholecystitis, septic shock, obstructive jaundice hepatitis sanyang, poor basic condition, and E. tarda, caused by a series of infections. Fortunately, before the culture results came out, clinicians empirically used imipenem and then bile cultured Escherichia coli. The changed cefoperazone sulbactam is also sensitive to E. tarda. Therefore, the overall anti-infective treatment effect as well, and the patient’s symptoms of the infection quickly improved. The reported that patients with E. tarda generally have underlying diseases, mainly including hepatobiliary diseases (cirrhosis, gallstones and alcohol abuse), malignant tumors (hepatobiliary and gastrointestinal tract) and iron overload status (sickle cells), leukemia, and neonatal status) [12]. In this case, the patient has chronic hepatitis B, gallstones, and bile duct stones, and a poor diet may increase the risk of E. tarda infection. In general, clinicians should consider the potential risk factors for E. tarda.

To sum up, we report a case of E. tarda with acute cholangitis, acute cholangitis, gallstones with acute cholecystitis, and septic shock. Although E. tarda is a rare pathogen, it can cause fatal infections similar to those caused by Aeromonas and Vibrio vulnificus [9]. Avoiding raw or undercooked food is a simple measure to prevent fatal foodborne infections. Clinicians should emphasize the importance of this for patients with potential risk factors.