cWe report a case in which fecal microbiota transplantation (FMT) utilized for relapsing Clostridium difficile colitis successfully eradicated colonization with several multidrug-resistant organisms (MDROs). FMT may have an additive benefit of reducing MDRO carriage and should be further investigated as a potential measure to eradicate additional potentially virulent organisms beyond C. difficile. CASE REPORTA 66-year-old male was admitted to Scripps Mercy Hospital in June of 2012 for debridement of a large sacral wound. His past medical history was significant for a spinal epidural abscess in March of 2011 that resulted in C4-level spinal cord injury (quadriplegia). His condition required residence in a skilled nursing facility and placement of a tracheostomy and a feeding tube and chronic Foley catheterization. While at the facility, he was found to be colonized by multiple multidrug-resistant (MDR) organisms (MDROs), including carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), and MDR Acinetobacter baumannii, and developed sepsis on a monthly basis during the 6 months preceding admission. Three days prior to admission, he was diagnosed with a CRE Klebsiella pneumoniae urinary tract infection (UTI).As a result of his ventilator-dependent condition and complex medical needs, he was admitted to the intensive care unit (ICU) at our facility. The sacral wound was treated with debridement and flap placement as well as a diverting colostomy. He was diagnosed with Clostridium difficile colitis during the first week of admission and treated with oral vancomycin (250 mg orally [p.o.] via a feeding tube 4 times/day). In addition, during the first 15 weeks of hospitalization, a variety of MDROs were isolated, including carbapenem-resistant (CR) Pseudomonas aeruginosa (respiratory tract), MDR Acinetobacter baumannii (wound and respiratory tract), CRE Klebsiella pneumoniae (wound), vancomycin-resistant Enterococcus faecalis (VRE) (wound), and MRSA (respiratory tract, urine, and abdominal fluid) (Fig. 1A). The patient received antibiotic courses for these infections, but these were limited to short courses due to concurrent C. difficile colitis and MDROs that were resistant to all or the majority of antibiotics.Despite continual oral vancomycin therapy for C. difficile colitis over the first 3.5 months of hospitalization, multiple episodes of relapsing C. difficile colitis occurred when vancomycin therapy was tapered. Hence, in September 2012, voluntary informed consent was obtained for a FMT. A stool donation was obtained from his sister, who underwent predonation blood and stool screening that excluded a variety of bacterial, parasitic, and viral pathogens (i.e., HIV, hepatitis A, B, and C virus, and Treponema pallidum [syphilis], plus stool examination for ova and parasites [O&P], C. difficile, and enteric pathogens). Vancomycin treatment was discontinued on the day prior to FMT, and the donor stool (480 ml) was transferred to the patient via a colonoscope. He tolerated the...

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Myroides sp., previously known as Flavobacterium odoratum, is a relatively unknown organism with unclear human pathogenicity. While Myroides sp. has been implicated in human infections, many reports have described the organism as a relatively avirulent opportunistic pathogen. We present an unusual case of rapidly fatal necrotizing fasciitis and septic shock due to Myroides odoratus. Our case demonstrates the pathogenicity of Myroides, and highlights potential risk factors for infection including underlying liver disease and open wounds. The recognition of Myroides is of particular importance given its resistance to multiple antibiotics. We review the literature on Myroides sp. skin and soft tissue infections, including necrotizing forms, and discuss the clinical presentation and management of this potentially emerging pathogen.

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