Fatal case of necrotizing fasciitis due to Myroides odoratus

Abstract

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.

Septicaemia caused by Myroides spp.: a case report

“…infection is often difficult, as most strains are resistant to the b-lactams, including aztreonam and carbapenems, and exhibit variable susceptibility to aminoglycosides, quinolones and sulfamethoxazole (Chang et al, 1997;Fass et al, 1996;Fraser and Jorgensen, 1997;Crum-Cianflone et al, 2014;Deepa et al, 2014;Green et al, 2001;Ktari et al, 2012;Maraki et al, 2012). The resistance to commonly used antibiotics and the variable susceptibility seen in these studies necessitate appropriate antimicrobial susceptibility testing, and an awareness among clinicians is essential for prompt switching of treatment from empirical antibiotics.…”

Myroides Infection in a Baboon After Prolonged Pig Kidney Graft Survival

“…A significant number of patients have been to some extent immunocompromised through, for example, liver cirrhosis, diabetes mellitus, or chronic obstructive pulmonary disease on long-term corticosteroid treatment. The organism has been responsible for soft tissue infection (26–31), including following a pig bite (32), surgical wound infection (33, 34), pneumonia (35), endocarditis (36), cerebral ventriculitis (37), and cholecystitis (38) (Table 2A). One patient died with a necrotizing fasciitis of both lower extremities and septic shock (31).…”

Antibiotic resistance mechanisms of Myroides sp.

“…Myroides sp. can cause soft tissue infection (Benedetti et al, 2011), cellulitis (Bachmeyer et al, 2007), necrotizing fasciitis (Crum-Cianflone et al, 2014), ventriculitis (Macfarlane et al, 1985), and urinary tract infections (Yağci et al, 2000). M. odoratimimus even caused an outbreak of urinary tract infection in a hospital (Ktari et al, 2012).…”

“…For example, a strain from a patient suffering from a hydatid cyst of the liver was sensitive to norfloxacin (An, 1992), but another strain isolated from pulmonary infection patient was reported to be resistant to norfloxacin (Liu and He, 2001). Two strains isolated from patients with cellulitis and a leg amputation, respectively (Hu et al, 2013;Crum-Cianflone et al, 2014) were resistant to ciprofloxacin, while another two isolated from trauma and septicemia patients, respectively, were sensitive to ciprofloxacin (Geng et al, 2000;Sun and Zhang, 2006).…”