Facklamia species are a rarely reported etiology of clinical infection with few cases described in literature. However, the prevalence of infection may be underestimated due to challenges in species identification. We describe 3 cases of Facklamia species bacteremia and the unique microbiologic aspects inherent to this genus that make it particularly challenging to identify. In addition, given the unique susceptibility profile of Facklamia species, we discuss the importance of fully identifying this organism when it is a suspected as a pathogen, to optimize therapy based on its distinct antibiotic resistance profile.
Fusobacterium species are well described as the causative pathogen in Lemierre’s syndrome, a suppurative thrombophlebitis of the jugular vein. However, they are less recognized for a unique variant of Lemierre’s syndrome presenting with invasive intraabdominal infection and associated portal vein thrombosis. We describe a case of Fusobacterium nucleatum with hepatic abscess and septic pylephlebitis.
BackgroundCRE is an urgent threats to public health with a high mortality estimated at >30–50%. Until recently, polymyxin-based antibiotics were the only available options. However, a new therapeutic option has become available: ceftazidime-avibactam. We sought to describe outcomes from these infections treated with ceftazidime-avibactam.MethodsFrom 9/2015 to 12/ 2016, we reviewed charts of 11 patients infected with CRE who received ceftazidime-avibactam at USC (Los Angeles, CA). Sixteen isolates analyzed. All isolates were resistant to meropenem (MIC ≥ 16). Carbapenemase production confirmed by detection of blaKPC. Clinical success defined as clinical improvement, lack of recurrence, and survival in 90 days. Recurrence defined as clinical signs of infection and recovery of CRE after ≥ 7 days of treatment.ResultsThe median age was 49 (35-89); 73% (7/11) female; and 27% (3/11) solid organ transplants. All CRE infections caused by Klebsiella pneumoniae. All sequence type 258, 7/11 harboring blaKPC-2 and 4/11 blaKPC-3. Nine capsular type wzi-154 and 2 wzi-29. qSOFA score was 0 (0–2) predicting mortality of 3%. Seven had intraabdominal infections; 2 pyelonephritis, 1 skin and soft-tissue infection, and 1 primary bacteremia. There were five episodes of secondary bacteremia. The patients were treated for a median duration of 15 (3-43) days. All received other antibiotics prior to ceftazidime-avibactam. Eighty-seven percent (9/11) treated with monotherapy and 13% (2/11) in conjunction with colistemethate sodium. 27% (3/11) were receiving CRRT or hemodialysis during treatment. No incidents of renal toxicity observed using RIFLE criteria. Clinical success was 73% (8/11); 30 day survival rate 82% (9/11); 90 day survival rate 73% (8/11); and in hospital mortality 27% (3/11). Patients receiving CRRT or hemodialysis had 75% (3/4) mortality (P = 0.02). Recurrence occurred in 18% (2/11). Decreased sensitivity to ceftazidime-avibactam noted in one patient. 27% (3/11) had CRE isolated after ≥ 7 days treatment.ConclusionIn CRE-infected patient treated with ceftazidime-avibactam, the overall mortality rate was 27% with the highest mortality among those receiving renal replacement therapy which was comparable to a prior studies. Additional research is needed to optimize the use of ceftazidime-avibactam to treat CRE infections.Disclosures All authors: No reported disclosures.
Introduction. Listeria monocytogenes is a rare etiology of infectious endocarditis with only 30 cases of prosthetic valve and about twice as many native valve infections described in the literature. We describe an unusual presentation of an endovascular embolic phenomenon with associated lower extremity mycotic aneurysm due to Listeria monocytogenes prosthetic aortic valve and aortic endograft infection. Case presentation. This is a case of an elderly gentleman with prior history of bioprosthetic aortic valve placement and aortic arch repair who was admitted with several weeks of constitutional symptoms and left lower leg pain. Diagnostic work-up was consistent with thrombosed popliteal artery aneurysm. Blood cultures were positive for Listeria monocytogenes. A transesophageal echocardiogram revealed vegetation on the bioprosthetic valve. The patient underwent arterial bypass and ligation of the aneurysm as well as redoing of his aortic valve and aortic graft replacement. Histopathology of the aortic valve was remarkable for acute inflammation and Gram-positive coccobacilli and bacilli occupying intracellular spaces. The results of broad-range bacterial 16S rRNA PCR and sequence analysis of unfixed aortic valve tissue confirmed detection of L. monocytogenes. Conclusion. Infective endocarditis attributable to species of the genus Listeriais a rare entity. As such, there are no specific guidelines for treatment of Listeria monocytogenesendocarditis. However, combination of penicillin or ampicillin with gentamicin is the most acceptable approach described in the literature. Our patient was treated with ampicillin and gentamicin for 6 weeks followed by life-long amoxicillin suppression therapy. The patient remained asymptomatic at a 6 months follow up visit.
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