Hasan Obada, Khan Wajiha, Jessar Muneeba, Pathan Aly Zaheer, Lakdawala Riaz Hussain
Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
Graduate MBBS, Aga Khan University, Karachi, Pakistan.
Int J Surg Case Rep. 2018;51:154-157. doi: 10.1016/j.ijscr.2018.08.037. Epub 2018 Aug 25.
Aeromonas are Gram-negative bacilli often causing necrotizing fasciitis or sepsis in immunocompromised patients. Aeromonas Hydrophila is most often found in immunocompromised patients or those with burns or aquatic trauma. When patients present with a discharge and infection on bone graft donor site and progressive sepsis, an Aeromonas hydrophila infection should be considered in the differential diagnosis.
We report here a rare case of Aeromonas hydrophila with surgical site sepsis/infection in an immunocompromised 69 years old female, with several comorbids. Here we are reporting infection on donor surgical graft site, sparing major surgical site with the implant. After getting culture report of exudates from the wound that grew A. hydrophila, immediate wound debridement and antibiotic beads insertion was performed with appropriate antimicrobial therapy and regular wound dressing. She was followed for around 2 years.
This is the first report to our knowledge of A. Hydrophila infection in bone graft donor site. Aeromonas most often cause gastrointestinal and soft tissue infections, and bacteremia in immunocompromised patients. Early surgical intervention is essential to reducing mortality in deep soft tissue infections caused by this organism. Aeromonas have shown resistance to penicillin but are sensitive to other broad-spectrum antibiotics.
Early suspicion, diagnosis, and treatment with potent antibiotics are needed to prevent any further complications resulting from infection by this emerging aggressive pathogen.
气单胞菌属革兰氏阴性杆菌,常导致免疫功能低下患者发生坏死性筋膜炎或败血症。嗜水气单胞菌最常见于免疫功能低下患者或有烧伤或水生创伤的患者。当患者在骨移植供体部位出现分泌物和感染以及进行性败血症时,鉴别诊断应考虑嗜水气单胞菌感染。
我们在此报告一例罕见的嗜水气单胞菌感染病例,患者为一名69岁免疫功能低下的女性,患有多种合并症,出现手术部位败血症/感染。此处报告的是供体手术移植部位感染,植入物所在的主要手术部位未受影响。在获得伤口渗出物培养报告显示生长出嗜水气单胞菌后,立即进行伤口清创并插入抗生素珠,同时给予适当的抗菌治疗和定期伤口换药。对她进行了约2年的随访。
据我们所知,这是首例关于骨移植供体部位嗜水气单胞菌感染的报告。气单胞菌最常引起免疫功能低下患者的胃肠道和软组织感染以及菌血症。早期手术干预对于降低由该病原体引起的深部软组织感染的死亡率至关重要。气单胞菌已显示对青霉素耐药,但对其他广谱抗生素敏感。
需要早期怀疑、诊断并用强效抗生素治疗,以预防由这种新出现的侵袭性病原体感染导致的任何进一步并发症。