meropenem and Lung-Abscess

Fusobacterium necrophorum, an anaerobic, gram-negative rod, belongs to the physiological flora of the oropharynx. It causes Lemierre's syndrome characterized by oropharyngeal infection, septic thrombophlebitis of the neck, in particular of the internal jugular vein, and metastatic abscesses, predominantly in the lungs. Rarely, and mainly in children, it causes meningitis. Here we report the clinical course of a 25-year-old woman with F. necrophorum meningitis. She presented with incomplete, right third nerve palsy. Within a few days, she developed fever, meningism and progressive reduction of vigilance. Cerebrospinal fluid analysis showed typical signs of bacterial meningitis. After the identification of F. necrophorum, the antibiotic treatment was changed to meropenem, which led to continuous improvement of the clinical symptoms. Due to persistent signs of inflammation in the CSF, metronidazole was added to the antibiotic regime. This case report demonstrates that F. necrophorum should always be considered in the diagnostic workup of bacterial meningitis in adults.

Topics: Adult; Anti-Bacterial Agents; Blood Glucose; Cerebrospinal Fluid Proteins; Diagnosis, Differential; Drug Therapy, Combination; Female; Fusobacterium necrophorum; Humans; Lactic Acid; Leukocyte Count; Lung Abscess; Meningitis, Bacterial; Meropenem; Metronidazole; Oculomotor Nerve Diseases; Otitis Media; Pharyngitis; Sepsis; Syndrome; Thienamycins

Lung abscess following flexible bronchoscopy is a rare and sometimes fatal iatrogenic complication. Here, we report the first case of a lung abscess caused by multidrug-resistant Capnocytophaga sputigena following bronchoscopy. A 67-year-old man underwent bronchoscopy to evaluate a lung mass. Seven days after transbronchial lung biopsy, he presented with an abscess formation in a lung mass. Empirical antibiotic therapy, including with garenoxacin, ampicillin/sulbactam, clindamycin and cefepime, was ineffective. Percutaneous needle aspiration of lung abscess yielded C. sputigena resistant to multiple antibiotics but remained susceptible to carbapenem. He was successfully treated by the combination therapy with surgery and with approximately 6 weeks of intravenous carbapenem. Finally he was diagnosed with a lung abscess with adenocarcinoma expressing high levels of programmed cell death ligand 1. The emergence of multidrug-resistant Capnocytophaga species is a serious concern for effective antimicrobial therapy. Clinicians should consider multidrug-resistant C. sputigena as a causative pathogen of lung abscess when it is refractory to antimicrobial treatment.

Topics: Aged; Anti-Bacterial Agents; B7-H1 Antigen; Biopsy, Fine-Needle; Bronchoscopy; Capnocytophaga; Drug Resistance, Multiple, Bacterial; Gram-Negative Bacterial Infections; Humans; Lung Abscess; Male; Meropenem; Sputum

In this report, a renal transplant recipient with Rhodococcus lung abscess is described. A high clinical suspicion and appropriate combination antibiotic therapy obviated the need for surgical intervention and was associated with a good clinical outcome. The optimal regimen of combination antibiotic therapy is discussed.

Topics: Actinomycetales Infections; Adult; Anti-Bacterial Agents; Drug Therapy, Combination; Humans; Kidney Transplantation; Lung Abscess; Male; Meropenem; Radiography; Rhodococcus equi; Rifampin; Sirolimus; Thienamycins; Treatment Outcome; Vancomycin