Fatal skin and soft tissue infection of multidrug resistant Acinetobacter baumannii: A case report

Abstract

INTRODUCTIONAcinetobacter baumannii is usually associated with respiratory tract, urinary tract and bloodstream infections. Recent reports suggest that it is increasingly causing skin and soft tissue infections. It is also evolving as a multidrug resistant organism that can be difficult to treat. We present a fatal case of multidrug resistant A. baumannii soft tissue infection and review of relevant literature.PRESENTATION OF CASEA 41 year old morbidly obese man, with history of alcoholic liver disease presented with left superficial pre-tibial abrasions and cellulitis caused by multidrug resistant (MDR) A. baumannii. In spite of early antibiotic administration he developed extensive myositis and fat necrosis requiring extensive and multiple surgical debridements. He deteriorated despite appropriate antibiotic therapy and multiple surgical interventions with development of multi-organ failure and died.DISCUSSIONManaging Acinetobacter infections remains difficult due to the array of resistance and the pathogens ability to develop new and ongoing resistance. The early diagnosis of necrotizing soft tissue infection may be challenging, but the key to successful management of patients with necrotizing soft tissue infection are early recognition and complete surgical debridement.CONCLUSIONA. baumannii is emerging as an important cause of severe, life-threatening soft tissue infections. Multidrug resistant A. baumannii soft tissue infections may carry a high mortality in spite of early and aggressive treatment. Clinicians need to consider appropriate early empirical antibiotic coverage or the use of combination therapy to include MDR A. baumannii as a cause of skin and soft tissue infections.

Explainable AI reveals changes in skin microbiome composition linked to phenotypic differences

“…For smoking, the top ML feature Acinetobacter was only at rank 91 th according to the t-test and other 6 genera were ranked below 100. Species within the Acinetobacter genus have been linked with respiratory and bloodstream infections which could explain their usefulness in smoking prediction with this being reflected in the leg microbiome (47). This indicates the set of most predictive genera inferred by our EAI approach can differ from the ones highlighted by a standard statistical approach that consider each genus independently.…”

Multidrug resistant Proteus mirabilis and Escherichia coli causing fulminant necrotising fasciitis: a case report

“…Multidrug resistance have been frequently reported in recent days and threatens the effectiveness of successful treatment of infections especially using empiric antibiotics. The incidence of MDR microbes is on the rise over the past decades, meanwhile many studies still advocate for early broad-spectrum empiric or combination antibiotic therapy [ 9 ]. Godebo et al in a study to determine multidrug resistance rate of bacterial isolates that caused wound infections in a specialised centre in SSA, showed that overall MDR among gram positive and gram negative bacterial isolates were 77 and 59.3% respectively [ 13 ].…”

“…The most common pathogens isolated from cultures are gram positive organisms like β -hemolytic group A streptococcus, Staphylococcus aureus , bacillus species, enterococci species and gram negative organisms such as Klebsiella pneumonia, Pseudomonas aeroginosa , Serratia species , Escherichia coli , Clostridium species, Fusobacterium species, and Prevotella species [ 2 , 7 , 8 ]. NF carries a high morbidity and mortality especially when diagnosed late [ 5 , 9 ] necessitating prompt diagnosis and timely treatment with radical surgical debridement and empiric broad spectrum antibiotic therapy [ 2 , 10 ]. The mortality rate due to NF ranges from 25 to 35% despite empiric broad-spectrum antibiotic therapy and surgical debridement [ 11 ].…”

Conservative treatment of fingertip injuries in children – first experiences with a novel silicone finger cap that enables woundfluid analysis

“…Further bacteria associated with wound infections in immunocompromised patients or after trauma respectively surgery, were identified in our specimen: Acinetobacter pitii [ 27 ], [ 28 ], [ 29 ] (a Gram-negative non-fermenting rod of growing clinical importance), Acinetobacter ursingii [ 30 ] (a species related to Acinetobacter baumannii ), Leclercia adecarboxylata [ 31 ], Citrobacter brakii [ 32 ] (both are Gram-negative rods belonging to the family of Enterocerobacteriacea), Bacillus cereus [ 33 ] and Bacillus pumilus [ 34 ], Gram-positive spore-forming rods, which are ubiquitously found in the environment and mostly regarded as contaminants. Brevibacillus parabrevis was detected in one case (patient ID 1).…”