Drowning and near-drowning can abruptly devastate the lives of both the affected victims and their families. In addition to the complications directly caused by the submersion, several indirect causes of morbidity exist. Infection is one of the complications associated with near-drowning, and pneumonia is the most severe of these infectious complications. The risk factors, microbiological causes, diagnostic approach, and appropriate therapy for pneumonia associated with near-drowning are not well described in the literature. Herein, we review the epidemiology and pathophysiology associated with near-drowning, discuss the potential mechanisms of infection, and describe the likely risk factors for pneumonia related to near-drowning. We also detail the microbiological causes of this entity and provide important clinical and epidemiological information associated with specific pathogens. Finally, we summarize an appropriate diagnostic and therapeutic approach to pneumonia associated with near-drowning.
In a whole genome-based phylogeny, clinical and fecal isolates of Escherichia coli sequence type 131 (H30R1 and H30Rx subclones) from six households formed household-specific clusters, interspersed among reference ST131 genomes. This supported the fecal-urethral hypothesis and confirmed within-household strain sharing.
Probable transmission of an extended-spectrum-beta-lactamase-producing Escherichia coli strain (sequence type ST131) between a father and daughter was documented. The father developed severe, recurrent pyelonephritis with multiple small abscesses; the daughter later developed septic shock, bacteremia, and extensive emphysematous pyelonephritis. This multidrug-resistant E. coli clone appears to be highly pathogenic and transmissible.
CASE REPORTPatient 1, a 68-year-old male, was admitted to the hospital with a 3-month history of poorly controlled diabetes mellitus, fever, weight loss, and malaise. A Foley catheter was placed for urinary retention, and urinary tract infection (UTI) was diagnosed. Therapy was started with levofloxacin but was changed to ertapenem when the urine culture revealed extended-spectrum-beta-lactamase (ESBL)-positive Escherichia coli. The patient received 10 days of ertapenem with clinical improvement and was transferred to a transitional care facility.Symptoms recurred soon thereafter. Repeat urine culture again showed ESBL-positive E. coli. Piperacillin-tazobactam was given for 7 days in the transitional care facility, without symptomatic improvement. The patient was admitted to a different hospital for further evaluation and management. Blood cultures were negative. Urinalysis revealed pyuria and bacteriuria; urine culture again grew ESBL-positive E. coli. Ertapenem was resumed, but fever persisted. Abdominal and pelvic computed tomography demonstrated bilateral pyelonephritis and numerous small abscesses within both kidneys (Fig.
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