Necrotising fasciitis caused byP aeruginosain a male patient with chronic lymphocytic leukaemia

Abstract

A 53-year-old man with chronic lymphocytic leukaemia and multiple comorbidities presented with a 2-day history of increasing pain and swelling in his left leg following a minor trauma, associated with signs of systemic sepsis and worsening multiorgan failure. The clinical picture was consistent with necrotising fasciitis and he was taken to the theatre for an above-knee amputation. Blood and tissue cultures grewPseudomonas aeruginosaonly, which is very rare as a monomicrobial infection, with relatively few cases being reported in the literature. The combination of aggressive timely surgical intervention, broad-spectrum antibiotics and treatment on the intensive care unit yielded a successful outcome from this acute episode.

Monomicrobial Necrotizing Fasciitis and Sepsis Caused by <i>Pseudomonas aeruginosa</i> and <i>Pseudomonas fluorescens</i>: a Series of Ten Cases

“…Pseudomonas aeruginosa is reported common causes of nosocomial infections, and exhibits resistance to a wide range of antibiotics. However, we did not find any resistant strains in our cases, and we used ceftazidime (9 cases) and ciprofloxacin ( Pseudomonas aeruginosa can cause rapidly progressive and fatal necrosis of fascia in the immunocompromised host (10)(11)(12)(13). Diabetes mellitus is an important predisposing illness, and affects the progression and severity of necrotizing fasciitis based on peripheral vaso-occlusion and sugar-coated capillaries limiting the blood supply to superficial and deep structures (6,7,24).…”

“…Pseudomonas aeruginosa infections of healthy skin are uncommon (14). Pseudomonas aeruginosa may cause localized epidermal infections (the green nail syndrome and webbed space infections), moderately serious infections (cutaneous folliculitis and otitis externa), and soft-tissue infections with peri-vasculitis secondary due to bacteremia (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Pseudomonas aeruginosa is reported common causes of nosocomial infections, and exhibits resistance to a wide range of antibiotics.…”

“…necrotizing fasciitis caused by Pseudomonas aeruginosa is exceptionally uncommon, and only few cases have been reported in the literature search (9)(10)(11)(12)(13)(14)(15)(16). Our previous study has reported three cases of monomicrobial necrotizing fasciitis caused by Pseudomonas aeruginosa, and one of them died (5) The enrolled patients were categorized into two groups: the death group and the survival group.…”

“…In addition, patients with malignancy, acute or chronic leukemia, renal transplantation recipient and childhood had been proposed as case report and most of them died (9)(10)(11)(26)(27)(28)(29). Reisman et al reviewed 17 of 37 cases with monomicrobial Pseudomonas necrotizing fasciitis had a hematological malignancy, in which 15 being treated with chemotherapy at the time of their infection (10).…”

Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients

“…In neutropenic patients, breakthrough infections with Pseudomonas aeruginosa can present as rapidly progressing pneumonia, bacteremia, and sepsis associated with mortality rates of 60–80% [ 1 ]. The involvement of other internal organs, limbs, and genitalia is less common but often requires timely surgical intervention in additional to broad-spectrum antibiotics [ 2 , 3 ]. Although the infection often arises endogenously following mucotoxic chemotherapy during neutropenia, exogenous acquisition and horizontal transmission of multidrug-resistant (MDR) strains have been documented via contaminated sinks, toilets, and bathrooms [ 4 , 5 , 6 ].…”