piperacillin--tazobactam-drug-combination and Opportunistic-Infections

Chromobacterium violaceum is a motile gram-negative bacterium. This bacterium commonly grows in tropical or subtropical areas in sewage and can cause opportunistic infections.. A 50-year-old Chinese man had a skin ulcer in the middle of his left leg in front of the tibia. The diameter of the wound was 3.0 cm, the exudation was obvious, and necrotic tissue was attached to the wound. One week previously, he was working in a field where he accidentally punctured his left leg.. C violaceum infection was diagnosed as per the results of pathogen culture from the infection site.. He was treated with piperacillin/tazobactam (3.375 g/12 h iv) and levofloxacin (0.5 g/24 h iv) for 5 days.. The patient showed good response to therapy and was discharged on day 18 after wound healing.. C violaceum rarely infects humans. When an infection is suspected, samples should be immediately sent for microbial culture. Timely treatment on the basis of drug sensitivity test results can prevent further complications.

Topics: Administration, Intravenous; Chromobacterium; Drug Therapy, Combination; Gram-Negative Bacterial Infections; Humans; Levofloxacin; Lower Extremity; Male; Middle Aged; Opportunistic Infections; Piperacillin, Tazobactam Drug Combination; Skin; Skin Ulcer; Treatment Outcome

Topics: Acinetobacter baumannii; Acinetobacter Infections; Adult; Aged; Anti-Bacterial Agents; Aspirin; Carbapenems; COVID-19; COVID-19 Drug Treatment; Critical Illness; Drug Resistance, Multiple, Bacterial; Female; Hospital Mortality; Humans; Intensive Care Units; Klebsiella Infections; Klebsiella pneumoniae; Length of Stay; Male; Middle Aged; Opportunistic Infections; Piperacillin, Tazobactam Drug Combination; Pneumonia; Retrospective Studies; SARS-CoV-2; Steroids; Survival Analysis; Treatment Outcome

Eggerthella lenta is a anaerobic gram-positive bacilli associated with polymicrobial intraabdominal infections. Recently, E. lenta was recognized as an important cause of anaerobic bloodstream infections (BSIs) associated with high mortality. Eggerthella lenta has been reported to have high minimal inhibitory concentrations (MICs) to piperacillin-tazobactam (TZP), a broad-spectrum antibiotic with anaerobic coverage commonly used in multiple centers for empiric treatment of abdominal sepsis.. We describe a retrospective population-based analysis of invasive E. lenta infections from 2009 through 2015. A logistic regression analysis for 30-day mortality risk factors was conducted.. We identified 107 E. lenta infections, 95 (89%) were BSIs, 11 (10%) skin and soft tissue infections, and 1 intraabdominal abscess. Polymicrobial infections were found in 40%; 72% of isolates were from a gastrointestinal source, most commonly appendicitis (33%) of which two-thirds were perforated. TZP MIC50 and MIC90 for E. lenta isolates were 32 μg/mL and 64 μg/mL, respectively. The overall 30-day mortality for BSI was 23% and was independently associated with empiric TZP monotherapy (odds ratio [OR], 4.4; 95% confidence interval [CI], 1.2-16; P = .02) and intensive care unit stay (OR, 6.2; 95% CI, 1.4-27.3; P = .01). Thirty-day mortality rates were significantly influenced by the use of different TZP MIC breakpoints.. Our results demonstrate the increased recognition of E. lenta as an anaerobic opportunistic pathogen and highlight the need for improved empiric antimicrobial guidelines and TZP MIC breakpoints with better correlation to clinical outcomes to guide appropriate management of invasive E. lenta infections.

Topics: Actinobacteria; Aged; Anti-Bacterial Agents; Bacteremia; Bacteria, Anaerobic; Disease Management; Female; Gram-Positive Bacterial Infections; Humans; Logistic Models; Male; Microbial Sensitivity Tests; Middle Aged; Opportunistic Infections; Piperacillin, Tazobactam Drug Combination; Public Health Surveillance; Retrospective Studies; Risk Factors; Treatment Outcome

Serratia marcescens is a saprophytic gram-negative bacillus capable of causing a wide range of infections. A 57-year-old female was admitted to our hospital for four weeks with community acquired pneumonia. A chest x-ray, six weeks after discharge, demonstrated multiple, bilateral 'cannon ball'-like opacities and mediastinal lymphadenopathy which were highly suspicious of disseminated malignancy or tuberculosis. The only symptom that this patient had was a productive cough. She had multiple commodities, but no specific immunodeficiency disorder. Interestingly, her sputum and bronchial washing samples grew S. marcescens. The computed tomography-guided lung biopsy demonstrated necrotic granulomatous changes. There was no pathological evidence of tuberculosis or fungal infection, malignancy or vasculitis. There are only a handful of reported cases of Serratia granulomas. Thus, we are reporting a rare instance of pulmonary Serratia marcescens granuloma radiologically mimicking metastatic malignancy and tuberculosis infection.

Topics: Anti-Bacterial Agents; Diagnosis, Differential; Female; Hospitalization; Humans; Opportunistic Infections; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia; Radiography, Thoracic; Serratia Infections; Serratia marcescens; Tomography, X-Ray Computed; Treatment Outcome; Tuberculosis