We report the first case of fulminant sepsis due to Wohlfahrtiimonas chitiniclastica. This case is also the first one reported in South America. We emphasize the importance of recognizing bacteria that live in the larvae of a parasitic fly as the causative agent of severe infections in homeless patients. CASE REPORTA 70-year-old homeless male patient was admitted to the emergency department of Eva Peron Hospital, Buenos Aires, Argentina, in June 2008 because of sensory impairment.He had a history of alcohol abuse, severe smoking, and occlusive peripheral arteriopathy of the lower limbs (with a 30% obstruction of the external iliac artery) without medical control since 1997.On admission, the patient was found to be disoriented, he did not answer simple commands, and he had isochoric pupils which showed hyporeactivity. His vital signs were as follows: nonrecordable blood pressure; pulse (heart) rate, 75 beats/ min; respiratory rate, 40 breaths/min; body temperature, 35°C (95°F), and signs of peripheral hypoperfusion.Physical examination revealed that the patient was in very poor sanitary condition.In both inguinal regions, the presence of multiple erythematous plaques covered by "honey-colored" crusts was observed; these lesions could not be cultivated.On respiratory auscultation, the patient showed coarse crackles in the right lower quadrant. Also, he presented weak peripheral pulses with no edema and jugular vein distention 2/3. The abdomen was soft and tender on palpation with preserved bowel sounds.The clinical picture was interpreted as a probable septic shock.Laboratory findings of the peripheral venous blood sample on admission were as follows: white blood cell count, 5,000/ mm 3 (with 86% neutrophils); hematocrit, 18.4%; hemoglobin count, 6.1 g/dl; and platelet count, 135,000/mm 3 . An arterial blood gas analysis showed a pH of 7. .8 meq/liter; blood urea nitrogen level, 406 mg/dl; and creatinine level, 12.6 mg/dl. Treatment with intravascular fluids (500 ml of 5% dextrose, 1,500 ml of saline [0.9%], and 100 mg thiamine) was initiated. A urinary catheter and central line were placed, and two blood culture sets and a urine culture were performed. Empirical treatment with ciprofloxacin (400 mg given every 12 h intravenously [i.v.]) and ampicillin-sulbactam (1.5 g every 6 h) was started.After admission to the intensive care unit (ICU), the patient presented sustained hypotension, hypoglycemia, respiratory failure, and oliguria, requiring the use of vasopressors (noradrenaline and dopamine), intravascular volume expansion, mechanical ventilation, and transfusion of 2 units of packed red blood cells.Hemodialysis was attempted on the third day of his intensive care unit stay, but it was not tolerated by the patient.The urine culture was negative and in the 2 blood culture sets (BacT/Alert; bioMérieux, Marcy l'Etoile, France) taken at the time of admission, at two different times, there was pure growth of Gram-negative rods. With the preliminary report of nonfermenting Gram-negative bacillus isolation in blood cu...

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Clinically significant NDM-1-producing Acinetobacter schindleri has not yet been described in the literature. We report the first case of bacteraemia due to an A. schindleri strain harbouring blaNDM-1 recovered from an immunocompromised patient. Our report reinforces the fact that NDM-1 can easily be acquired by Acinetobacter species.