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J Med Case Rep. 2018 Nov 1;12(1):326. doi: 10.1186/s13256-018-1854-1.

Multidrug-resistant Aeromonas hydrophila causing fatal bilateral necrotizing fasciitis in an immunocompromised patient: a case report.

Author information

1
Department of Medicine, University of Calgary, 9-3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada.
2
Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada.
3
Department of Medicine, University of Calgary, 9-3535 Research Rd NW, Calgary, AB, T2L 2K8, Canada. deirdre.church@cls.ab.ca.
4
Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada. deirdre.church@cls.ab.ca.
5
Department of Medicine, Snyder Institute for Chronic Diseases, Cummings School of Medicine, University of Calgary, Calgary, Canada. deirdre.church@cls.ab.ca.

Abstract

BACKGROUND:

Aeromonas hydrophila is a water-dwelling, gram-negative rod-shaped bacterium, associated with diarrheal illness and, less commonly, necrotizing skin and soft tissue infections, especially among immunocompromised patients. Necrotizing fasciitis is associated with a high mortality rate, especially when caused by Aeromonas spp. Our patient was infected with an extremely aggressive form of multidrug-resistant Aeromonas spp. that produced both an extended-spectrum β-lactamase and an AmpC enzyme. Aeromonads are being recognized as important emerging pathogens because of their inherent antibiotic resistance profiles compounded by other virulence factors. These difficult-to-treat organisms can have significant implications in both clinical and public health settings.

CASE PRESENTATION:

A 37-year-old Caucasian male with immunosuppression due to aplastic anemia being treated with cyclosporine, presented to hospital with relapsed disease. While in hospital, he subsequently developed overwhelming sepsis secondary to bilateral lower extremity necrotizing fasciitis. The necrotizing fasciitis was caused by a multidrug-resistant strain of A. hydrophila. Despite broad-spectrum antibiotics and aggressive surgical debridement, he succumbed to this severe invasive infection.

CONCLUSIONS:

Necrotizing fasciitis caused by Aeromonas spp. is a rare infection that may have a poor clinical outcome, particularly if the diagnosis is delayed and/or the organism is highly virulent and multidrug resistant. Enhanced education of clinicians and microbiologists is required to prevent unnecessary complications and improve survival.

KEYWORDS:

Aeromonas hydrophila; Multidrug resistance; Necrotizing fasciitis

PMID:
30382899
PMCID:
PMC6211551
DOI:
10.1186/s13256-018-1854-1
[Indexed for MEDLINE]
Free PMC Article

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