Aeromonas hydrophila is a motile, nonsporulating, fermentative, facultative, anaerobic, gram-negative bacillus commonly found in fresh water, tap water, soil, and swimming pools. 1,2 Human infections caused by Aeromonas spp. are frequently associated with trauma in the aquatic environment, 3-7 immunosuppression, 7 and chronic disease. 8 -Lactam resistance in Aeromonas spp. has been reported. 9 In clinical Aeromonas isolates, genetic properties of the -lactamase genes have been characterized. 9 -12 Previous reports 9,13 demonstrated that Aeromonas spp. can produce multiple -lactamases, including a carbapenem-hydrolyzing metallo--lactamase, which is an important problem for antibiotic treatment.Vibrio alginolyticus is a facultatively anaerobic, gramnegative bacillus with a single polar flagellum for mobility. 14 V. alginolyticus, a halophilic bacterium, is common in coastal waters and sediments all over the world. 15 Human infections caused by V. alginolyticus include ear, soft tissue, and wound infections. 14,16,17 Recent reports 18 showed that 40% of V. alginolyticus isolated from the environment produce -lactamases conferring resistance to ampicillin. Antibiotic resistance in V. alginolyticus is a significant problem for wound infections related to the aquatic environment.We describe a wound infection caused by both A. hydrophila and V. alginolyticus related to an aquatic environment. Genetic analysis suggests that microbiologic examination is critical, because these aquatic environment-related isolates had a variety of determinants of antibiotic resistance.
CASE REPORTA 37-year-old man had fallen out of a boat at Hamana Lake in Japan, twining his left fingers in a rope, and the left second and third digits were amputated in 2001. The amputated digits were exposed to the lake water for several minutes to an hour. He was admitted to a Hamamatsu city hospital. At admission, laboratory examination revealed a C-reactive protein concentration of 1 mg/L (normal, 0 -1 mg/L), a white blood cell count (WBC) of 12.9 ϫ 10 9 cells/L (normal, 3.5-8.9 ϫ 10 9 cells/L), and a platelet count of 281 ϫ 10 9 /L (normal, 147-332 ϫ 10 9 /L). After surgical treatment with replantation and stump plasty, intravenous cefazolin 2 g administered twice daily was started. However, the replantated fingers had necrosis and wound infection. On hospital day 12, the fingers were removed. Both A. hydrophila SHH-029 and V. alginolyticus SHH-031 were isolated from wound fluid collected on day 12. Then, antibiotic therapy was changed to intravenous imipenem 0.5 g administered twice daily. Laboratory examination revealed a C-reactive protein concentration of 57 mg/L, a white blood cell count of 12.1 ϫ 10 9 cells/L, and a platelet count of 456 ϫ 10 9 /L. Minimum inhibitory concentrations (MICs) were determined by the agar dilution method as described by the National Committee for Clinical Laboratory Standards. 19 Susceptibility testing was performed on Mueller-Hinton agar (Nippon Becton Dickinson, Tokyo, Japan). The results of susceptibility testi...