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Acinetobacter Infections — Overview of Clinical Features
Published in E. Bergogne-Bénézin, M.L. Joly-Guillou, K.J. Towner, Acinetobacter, 2020
Itzchak Levi, Ethan Rubinstein
Acinetobacter cholangitis and septic complications following percu-taneous transhepatic cholangiogram (PTC) and percutaneous biliary drainage (PBD) occur primarily among elderly patients with obstructive jaundice caused by malignant disease or choledocholithiasis. In one study, 13.5% of patients developed sepsis, with the most common isolates being Enterobacter cloacae and A. baumannii (Sacks-Berg et al., 1992). Other more rare case reports include typhilitis after autologous bone marrow transplantation (Nagler et al., 1992), and osteomyelitis and extremities infections following injury (Dietz et al., 1988; Martin et al., 1988). Eye infections following trauma have also been described (Mark and Gaynon, 1983). Both A. baumannii and A. Iwoffii (Melki and Sramek, 1992) have been implicated in trauma-induced endophthalmitis. Penetrating keratoplasty (Zabel et al., 1989) and the fitting of contact lens (Barre and Cook, 1984) have also caused ophthalmic infections with Acinetobacter.
Bloodstream Infections
Published in Firza Alexander Gronthoud, Practical Clinical Microbiology and Infectious Diseases, 2020
Most common sources are urinary tract, intra-abdominal, biliary tract and, in hospitalized patients, also the respiratory tract. Not typically associated with endocarditis. Enterobacter cloacae complex should not be treated with cephalosporins owing to chromosomal production of AmpC enzyme, unless it is fully sensitive, including to amoxicillin/clavulanic acid and cefuroxime (see Chapters 2.6 and 5.1).
Medications and substances of abuse
Published in James W. Albers, Stanley Berent, Neurobehavioral Toxicology: Neurological and Neuropsychological Perspectives, 2005
James W. Albers, Stanley Berent
Six days after transfer she was weaned from ECMO and paralytic medications. At this time, she was noted to have extremity muscle weakness, but the examination was limited because she was sedated and poorly responsive. Persistent weakness was documented in the progress notes, but it was attributed to her underlying medical condition. The hospital course was complicated by Enterobacter cloacae pneumonia and sepsis. Both were identified early and treated appropriately. She was successfully extubated 17 days after the onset of her illness. Following extubation, neurologic examination documented severe weakness (graded in the 1+ to 3+ range). Distal muscles were more involved than were proximal muscles, and some muscles (e.g., the biceps brachii) demonstrated only minimal contraction. Mental status and sensory examinations were intact. Reflexes could not be elicited.
Single-dose intravesical amikacin instillation for pyocystis in a patient with autonomic dysreflexia: A case report
Published in The Journal of Spinal Cord Medicine, 2022
Erin Sherwin, Cynthia King, Howard Hasen, Shari May
Current data to support intravesical aminoglycoside irrigations for infections of the urinary tract are limited to case reports and observational studies. Elsayed and colleagues reported the use of gentamicin irrigations to treat pyocystis in a 68-year-old male with ESRD on hemodialysis.9 The infective organism was Trueperella bernardiae, a Gram-positive opportunistic pathogen. The patient received IV ceftriaxone with intravesical gentamicin and normal saline irrigations three times daily for a total of 4 days. The patient’s symptoms improved and he was transitioned to oral cefuroxime for 5 days. Wood and colleagues reported a case of a 69-year-old female treated with continuous tobramycin irrigations (40 mg/1,000 mL in sterile water) at 42 mL/hour for a total of 4 days. Follow-up urine culture revealed no growth of the infective organism Enterobacter cloacae.10 A report from Gonzalez and colleagues describes the use of continuous amikacin irrigations for E. coli cystitis emphysematous in a 60-year-old female.11 She also received IV amikacin and ceftriaxone. Treatment resulted in eradication of the organism.
Phenotypic synergy testing of ceftazidime–avibactam with aztreonam in a university hospital having high number of metallobetalactamase producing bacteria
Published in Infectious Diseases, 2020
Chinmoy Sahu, Sourav Pal, Sangram Singh Patel, Sanjay Singh, Mohan Gurjar, Ujjala Ghoshal
Ceftazidime–avibactam has been studied in many randomized controlled trials for treatment of complicated UTI, HAP and intra-abdominal infections (IAI) [19–21]. All the studies found non-inferiority of ceftazidime-avibactam over comparators. However, clinical studies of combination of ceftazidime–avibactam with aztreonam are less. In one case report, patient of CRBSI due to NDM and OXA-48 producing K. pneumoniae did not respond to colistin and amikacin [22]. However E-strip-E-strip testing indicated synergy between ceftazidime–avibactam and aztreonam. The patient was given combination therapy of both the antibiotics and responded. The same report also mentioned another patient of pneumonia due to NDM and AmpC producing P. aeruginosa. He recovered quickly after combination therapy as indicated by synergy testing. Another case report mentioned successful treatment of hip arthroplasty infection by Enterobacter cloacae by the antibiotic combination [5]. This synergy was also reported by disc:disc overlapping method. In our cases, four patients responded to the combination treatment. All four bacteria causing the infections were positive for synergy testing and all were resistant to colistin. The rapid reporting of synergy helped the clinicians to take decisions for antibiotic selection.
Recurrent FUO due to intermittent Enterobacter cloacae bacteremias from an infected pacemaker lead diagnosed by gallium scan
Published in Infectious Diseases, 2018
After his first visit to our office, additional blood cultures were ordered, but were negative. His fever recurred two weeks later prompting a visit to another hospital’s emergency department (ED). He was discharged home, but a day later he was informed his blood cultures (4/4) were positive due to Enterobacter cloacae. Except for splenomegaly, abdominal CT scan was unremarkable. Transthoracic echocardiogram (TTE) and transesophageal echocardiogram (TEE) were negative for vegetations. He was treated with piperacillin/tazobactam for a week and was discharged home on oral ciprofloxacin for two more weeks. However, following antibiotic therapy, episodic fevers/chills returned. Two months later, during another episode of fever and chills, he was evaluated at another ED, and blood cultures were again positive (2/2) for Enterobacter cloacae. He was again treated with a course of parenteral and oral antibiotics, but his fever/chills recurred.