Macrolide/fluoroquinolone‐resistant Campylobacter jejuni‐induced cellulitis in a patient with X‐linked agammaglobulinaemia successfully treated with carbapenem

Abstract

Cellulitis is a bacterial infection in the deep dermal layer and subcutaneous tissue. It usually manifests as erythema, tenderness, and swelling of the skin. Streptococcus pyogenes and Staphylococcus aureus are known as major causes of cellulitis. 1 Campylobacter jejuni is one of the most common causes of foodborne enteric infections in developing countries and may cause refractory cellulitis in immunocompromised patients. 2 Here we report a case of multidrug-resistant C. jejuni cellulitis in an X-linked agammaglobulinaemia patient.A 42-year-old male was referred to our department with a 6-month history of unresolved swelling in the right lower leg. The patient was diagnosed with X-linked agammaglobulinaemia at 3 years of age and had undertaken monthly intravenous infusions of immunoglobulin. He also had been treated with clarithromycin (200 mg/day) for chronic bronchitis and chronic sinusitis for over 10 years. During our physical examination, a diffuse erythematous lesion with tenderness on the right lower leg was observed (Figure 1A). Laboratory examinations showed elevated C-reactive protein (CRP) (7.44 mg/dl; reference value: 0-0.14 mg/dl), but a white blood cell count within the normal range (6600/μl; reference value: 3300-8600/μl).The skin lesion was diagnosed as bacterial cellulitis, and we started antibiotic treatment with cefaclor (750 mg/day). However, the lesion did not improve. We then started the administration of oral minocycline (200 mg/day) for 30 days; however, the patient's skin symptoms appeared intractable. A blood culture test detected C. jejuni that was resistant to macrolides and fluoroquinolones. We changed the treatment to intravenous meropenem (1000 mg/day) (Figure 1B). After 6 days, the symptoms of cellulitis were considerably relieved, along with decreases in CRP levels (Figure 1C). At that time, C. jejuni was not detected in blood culture tests. We continued to administer intravenous

Recurrent Campylobacter jejuni Infections with In Vivo Selection of Resistance to Macrolides and Carbapenems: Molecular Characterization of Resistance Determinants

“…Carbapenems are usually reserved for the treatment of serious cases of Campylobacter infection, like those complicated by bacteremia ( 37 , 38 ). The lack of reported resistance to these antibiotics means it is usually the first-line choice in drug-resistant infections ( 39 ). The initial isolates considered here (A1, B1) were susceptible to both imipenem and meropenem, with isolate B1 already showing low-level resistance to ertapenem.…”