piperacillin--tazobactam-drug-combination and Liver-Abscess

Herein we report two cases of infections caused by Tissierella praeacuta and a review of the literature. The first case was a septic pseudarthrosis of the left femur after multiple fractures. Two per-operative samples were positive with T. praeacuta. The patient was successfully treated by piperacillin - tazobactam and metronidazole. The second case was a bacteremia in a patient suffering from pyonephrosis and a hepatic abscess. The treatment was meropenem. No relapses were observed in both cases. Identification of the strains using MALDI-TOF coupled to mass spectrometry (MS) (Beckman coulter, France) was inconclusive in the two cases. Identification by 16S rRNA sequencing was then performed. This bacterium was susceptible to beta-lactams, chloramphenicol, rifampicine and metronidazole.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Bacterial Typing Techniques; Femoral Neck Fractures; Femur; Firmicutes; Humans; Liver Abscess; Meropenem; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Polymerase Chain Reaction; Pseudarthrosis; Pyonephrosis; RNA, Ribosomal, 16S; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization; Thienamycins; Treatment Outcome

Liver abscess secondary to a migrated ingested foreign body is an uncommon condition where early diagnosis helps management and improves prognosis. Abscess drainage with removal of the foreign body is the recommended management. We report the successful management of a patient with a liver abscess from a migrated fishbone that was treated medically with the foreign body left in situ.

Topics: Abdominal Pain; Animals; Anti-Bacterial Agents; Bone and Bones; Diagnosis, Differential; Drug Therapy, Combination; Female; Foreign Bodies; Foreign-Body Migration; Humans; Liver Abscess; Metronidazole; Middle Aged; Piperacillin, Tazobactam Drug Combination; Seafood; Tomography, X-Ray Computed

Topics: Abdominal Pain; Anti-Bacterial Agents; Bacteremia; Ceftriaxone; Fusobacterium Infections; Fusobacterium necrophorum; Humans; Liver Abscess; Male; Metronidazole; Middle Aged; Nausea; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Sepsis; Treatment Outcome; Vomiting

This report describes the first confirmed case of isolated pyomyositis caused by a hypervirulent strain of Klebsiella pneumoniae. Pyomyositis is almost universally caused by gram-positive organisms and while the recent emergence of invasive disease due to hypervirulent K. pneumoniae has been well documented, the most common clinical manifestation reported is liver abscess. The K. pneumoniae isolate in our case had a hypermucousviscous phenotype as demonstrated by a positive string test and was confirmed to be hypervirulent with molecular testing. Documenting the extrahepatic manifestations of hypervirulent Klebsiella pneumoniae strains is important to increase clinical awareness and in guiding empiric antibiotic regimens.

Topics: Anti-Bacterial Agents; Drug Resistance, Multiple, Bacterial; Humans; Klebsiella Infections; Klebsiella pneumoniae; Levofloxacin; Liver Abscess; Male; Middle Aged; Penicillanic Acid; Phenotype; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pyomyositis; Vancomycin