Multidrug-resistant Aeromonas hydrophila causing fatal bilateral necrotizing fasciitis in an immunocompromised patient: a case report

Abstract

BackgroundAeromonas hydrophila is a water-dwelling, gram-negative rod-shaped bacterium, associated with diarrheal illness and, less commonly, necrotizing skin and soft tissue infections, especially among immunocompromised patients. Necrotizing fasciitis is associated with a high mortality rate, especially when caused by Aeromonas spp. Our patient was infected with an extremely aggressive form of multidrug-resistant Aeromonas spp. that produced both an extended-spectrum β-lactamase and an AmpC enzyme. Aeromonads are being recognized as important emerging pathogens because of their inherent antibiotic resistance profiles compounded by other virulence factors. These difficult-to-treat organisms can have significant implications in both clinical and public health settings.Case presentationA 37-year-old Caucasian male with immunosuppression due to aplastic anemia being treated with cyclosporine, presented to hospital with relapsed disease. While in hospital, he subsequently developed overwhelming sepsis secondary to bilateral lower extremity necrotizing fasciitis. The necrotizing fasciitis was caused by a multidrug-resistant strain of A. hydrophila. Despite broad-spectrum antibiotics and aggressive surgical debridement, he succumbed to this severe invasive infection.ConclusionsNecrotizing fasciitis caused by Aeromonas spp. is a rare infection that may have a poor clinical outcome, particularly if the diagnosis is delayed and/or the organism is highly virulent and multidrug resistant. Enhanced education of clinicians and microbiologists is required to prevent unnecessary complications and improve survival.

Isolation, characterization and genomic analysis of vB‐AhyM‐AP1, a lytic bacteriophage infectingAeromonas hydrophila

“…Aeromonas hydrophila is a ubiquitous, Gram-negative bacterium that is pathogenic to warm and cold-blooded animals (Rasmussen-Ivey et al 2016a;Zhou et al 2019). These are commonly isolated from a variety of sources such as fresh and brackish water systems, seafood, meat, dairy products, vegetables, chlorinated water as well as hospital water supplies (Ugarte-Torres et al 2018). It is the causative agent of motile Aeromonas septicemia in fish resulting in internal and external haemorrhages, tail rot, exophthalmia and mortality within a short time of infection (Rasmussen-Ivey et al 2016b).…”

Expression of a Shiga-Like Toxin during Plastic Colonization by Two Multidrug-Resistant Bacteria, Aeromonas hydrophila RIT668 and Citrobacter freundii RIT669, Isolated from Endangered Turtles (Clemmys guttata)

“…They can cause gastroenteritis, bacteraemia, peritonitis and infections of the respiratory system, hepato-biliary system, urinary tract, eyes and wounds [32,33]. Necrotizing fasciitis has also been reported with A. hydrophila as the causative agent [34,35]. Outbreaks of diarrhea have also been reported [36].…”

Prevalence of Potentially Pathogenic Antibiotic-Resistant Aeromonas spp. in Treated Urban Wastewater Effluents versus Recipient Riverine Populations: a 3-Year Comparative Study

“…Due to their high presence in aquatic environments and various antibiotic-resistant mechanisms, this genus could identify as indicator bacteria for aquatic environmental antibiotic-resistant dissemination (12). Health concerns related to drug-resistant aeromonad populations are 2-fold: Aeromonas has a pathogenic nature makes it more difficult to treat clinically (11,(13)(14)(15), and it has the potential to act as a reservoir of ARGs capable of transferring to other pathogenic bacteria through horizontal gene transfer (16,17).…”