amoxicillin-potassium-clavulanate-combination and Aortic-Aneurysm--Abdominal

A 67-year-old man presented to our hospital with general malaise, fever and diffuse abdominal and lower back pain 7 weeks after endovascular aneurysm repair. Blood samples showed a leukocyte count of 10.9 x 10(9)/l and a C-reactive protein of 239 mg/l. The computed tomography (CT)-scan showed fluid collections behind the proximal part of the endovascular graft and dorsal to the aorta. CT-guided translumbar needle aspiration of these collections yielded growth with Listeria monocytogenes. Prosthetic endograft infection is an extremely rare event, especially when it is caused by L. monocytogenes. Given the scarcity of this complication, no consensus has been reached for its treatment. In the described case, radiological drainage and prolonged antibiotic treatment resulted in favourable outcome at midterm follow-up with preservation of the endograft.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Anti-Bacterial Agents; Aortic Aneurysm, Abdominal; Aortography; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Drainage; Humans; Listeriosis; Male; Positron-Emission Tomography; Prosthesis-Related Infections; Stents; Tomography, X-Ray Computed; Trimethoprim, Sulfamethoxazole Drug Combination

Nontyphoidal salmonellae are among the most common causes of bacterial gastroenteritis worldwide. They are also notable causes of extraintestinal infections, including bacteremia and vascular infections. Salmonella enterica serotype Choleraesuis is typically associated with invasive infections. We report a patient who had an infected intra-abdominal aortic aneurysm due to an unusually mucoid strain of Salmonella enterica serotype Choleraesuis. The isolate was erroneously identified as Hafnia alvei by the Vitek GNI+ card system. A blood culture isolate taken from the same patient 9 months earlier was also identified as H. alvei by the Vitek GNI+ card system. Despite an apparent cure with intravenous amoxicillin-clavulanic acid at that time, the Salmonella infection had not been cleared and manifested as a ruptured infected abdominal aortic aneurysm. Repeated passage of the strain yielded nonmucoid colonies, which were correctly identified by the API and PHOENIX systems. The isolates from the aneurysm and the former bacteremic episode were found to be identical using pulsed field gel electrophoresis. The fallibility of automated bacterial identification systems is highlighted. Such errors are especially important for isolates in which in vitro antibiotic susceptibility testing does not correlate with the clinical success of treatment, as illustrated by Salmonella infections.

Topics: Aged; Amoxicillin-Potassium Clavulanate Combination; Aortic Aneurysm, Abdominal; Bacteriological Techniques; Blood; Diagnostic Errors; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae Infections; Hafnia alvei; Humans; Male; Salmonella enterica; Salmonella Infections