We report three cases of infection due to the Gram-negative rod Ignatzschineria (Schineria) indica involving bacteremia and the urinary tract. Two cases were clearly associated with maggot infestation, and the third could conceivably have had unrecognized maggot infestation of the urinary tract. We believe these cases to be the first I. indica infections reported in association with maggot infestation and myiasis. CASE REPORTSC ase 1 is a 64-year-old homeless male who presented to the emergency department at the University of Louisville Hospital with the chief complaint of a painful left foot. His pertinent medical history included a motor vehicle accident 2 months prior to this admission, at which time he sustained lacerations to the dorsal aspect of the first three digits of his left foot. Because of his social situation, he had been unable to treat his wounds or change the dressings since the accident. He complained of extreme pain in the foot, which was exacerbated with any movement or pressure. He reported no other symptoms or past medical history. On physical examination, his left foot was edematous and erythematous surrounding the bandages. Following removal of the dressings, the wound revealed malodorous lacerations located on the dorsum of the foot and along the border of digits 1, 2, and 3 which expressed serous drainage. Maggots were observed in the wound and between the digits. All pedal pulses were palpable. Vital signs and the remainder of the physical examination were unremarkable.Laboratory studies revealed a normal white blood cell count (8,800/l with 64.2% granulocytes), an elevated erythrocyte sedimentation rate (ESR [57 mm/h]) and elevated C-reactive protein (CRP) level (1.06 mg/dl). X ray of the left foot demonstrated mild dorsal soft tissue swelling with no acute fracture or dislocation. However, magnetic resonance imaging (MRI) of the foot showed a fracture of the third middle phalanx with adjacent soft tissue defect. The clinical impression was osteomyelitis, although not seen on imaging, and the patient was started on empirical ampicillin-sulbactam (3 g intravenous [i.v.] every 6 h [q6h]) and vancomycin (1.25 g i.v., q12h). His wounds were redressed wet to dry with Dakin's solution, and the necrotic tissue was debrided with removal of the maggots. Despite conservative treatment, the third digit was considered unsalvageable, and the patient was taken to surgery for amputation of the digit. Histopathology noted skin ulceration and prominent acute and chronic inflammation extending to the soft tissue margin. On the second day postadmission, two aerobic blood cultures were positive for nonhemolytic Gram-negative short plump rods. The isolate produced a "yellowish" pigment on blood agar. The oxidase and indole tests were, respectively, positive and negative. The organism was identified as Alcaligenes faecalis (97% probability) (RapidID NF Plus; Remel, Lenexa, KS). Attempts to perform susceptibility testing were unsuccessful due to the organism's not growing in the Microscan Gram-negative pane...