Lung Abscess Due to  -Lactamase-Producing Pasteurella multocida

Abstract

Pasteurella multocida is a commensal of the upper respiratory tract of various animals. The spectrum of human diseases caused by P. multocida varies from soft-tissue infections following bites and scratches to systemic infections, including respiratory tract infections resulting from airborne contamination and/or chronic carriage. Antimicrobial resistance of Pasteurella strains originating from animals has been reported for many years. Human P. multocida isolates are usually susceptible to penicillins. We report a case in which a strain of b-lactamase-producing P. multocida was isolated from a lung abscess specimen and review related cases.A 75-year-old woman with chronic bronchitis was hospitalized with fever (temperature, 40ЊC), weight loss, increased productive cough, and dyspnea. A chest x-ray was unremarkable, whereas the WBC count was 13,900/mm 3 (89% neutrophils) and the one-hour erythrocyte sedimentation rate was 63 mm/h. The patient was treated for 8 days with intravenous amoxicillin (1.5 g/d). Because of persistent signs of infection, a new chest radiograph was obtained, which showed a left lung abscess; the abscess was confirmed by CT. Culture of specimens obtained by bronchoalveolar lavage yielded P. multocida subspecies multocida (10 5 cfu/mL) and Haemophilus parainfluenzae (10 3 cfu/ mL).Production of b-lactamase by both isolates was detected by a chromogenic test using nitrocefin-impregnated disk and the synergic effect between clavulanate and amoxicillin by disk diffusion testing. Minimum inhibitory concentrations of amoxicillin and amoxicillin/clavulanate for the P. multocida strain were of 8 and 0.25 mg/mL, respectively. Consequently, amoxicillin was changed to intravenous amoxicillin/clavulanic acid (3 g/d). A favorable outcome was achieved, and the patient was discharged from the hospital; medication at the time of discharge was oral amoxicillin/clavulanic acid for 2 months. Our patient had no known exposure to animals other than her cat. Two different strains of P. multocida (subspecies multocida and septica) were isolated from the cat's saliva, but none of them was found to produce b-lactamase.A MEDLINE search of the literature revealed only 4 welldocumented cases of human infections due to penicillin-resistant P. multocida [1][2][3][4]. All 4 cases were respiratory tract infections. The principal features of these cases along with our case are presented in table 1. The respiratory tract is the most common site of pasteurella infections after soft tissues [5]. Previous studies have shown that impaired pulmonary defenses,

Pasteurella multocida peritonitis associated with a cat in a peritoneal dialysis patient using an automated cycler device

“…The two cases were improved by changing them to appropriate antibiotic therapy and PD catheter removal. Pasteurella species might be penicillin-resistant because they produce b-lactamase; therefore, ampicillin/sulbactam, piperacillin/tazobactam, and amoxicillin/clavulanate are recommended for the treatment of P. multocida [24,25]. Patients that display cloudy effluent after being treated with appropriate antibiotics for 5 days have refractory peritonitis and should have their catheter removed [26].…”

Review of Pasteurella multocida Infections over a Twelve-Year Period in a Tertiary Care Hospital

“…Although susceptibility of human P. multocida isolates to beta-lactams is almost universal [27] , betalactamase production by some isolates has been reported and thus susceptibility testing should always be performed [28,29] . Susceptibility to tetracycline, chloramphenicol and ciprofloxacin has been demonstrated, while inconsistent clinical results may be found with aminoglycosides, erythromycin, clindamycin and vancomycin [4,19] .…”

Chronic Lung Abscess with Pasteurella multocida Infection

“…Lower respiratory tract infections, including pneumonia, empyema, and lung abscess, have been documented in subjects with underlying chronic pulmonary disease and, more recently, in one patient with AIDS (2). We were able to find only ten reports of lung abscess due to P. multocida (3)(4)(5)(6)(7)(8)(9)(10)(11)(12).…”