PDF(Pubmed)
Abstract：
Gram-negative bacteremia in hospitalized patients often leads to prolonged hospital stays, increased healthcare costs, and mortality rates. Simultaneously, the presence of comorbidities like chronic wounds increases the risk of severe infection and complicated hospital courses involving amputation, broad-spectrum antibiotic use, and repeat hospital admissions, after discharge. This case presents a 72-year-old male with a past medical history significant for chronic lower extremity cellulitis with multiple prior hospitalizations. On admission, the patient had a chief complaint of progressively worsening left lower extremity pain along with nausea, vomiting, and diarrhea. CT imaging of the left lower extremity suggested severe cellulitis without signs of osteomyelitis. Blood cultures initially suggested Corynebacterium jeikeium, but were sent to an outside facility due to ambiguity of results. The outside facility identified the pathogen as Ignatzschineria indica. After confirming the results, antibiotics were appropriately de-escalated to oral levofloxacin. The patient continued to show clinical improvement and was discharged with follow-up appointments scheduled for infectious disease and bi-weekly visits to wound care. Considering the increasing prevalence of chronic wounds in the United States, awareness and recognition of emerging pathogens are crucial for the timely diagnosis, treatment, and management of these complex patients. Our case adds to the growing body of reports on the management of I. indica bacteremia resulting from maggot-infested wounds.
摘要：
住院患者的革兰氏阴性菌血症通常会导致住院时间延长，医疗费用增加，和死亡率。同时,慢性伤口等合并症的存在增加了严重感染和涉及截肢的复杂医院疗程的风险，广谱抗生素的使用，再次入院，出院后。该病例为一名72岁的男性，其既往病史对慢性下肢蜂窝织炎具有重要意义，并多次住院。一入场,该患者的主诉是左下肢疼痛逐渐恶化并伴有恶心，呕吐,和腹泻。左下肢CT影像提示严重蜂窝织炎，无骨髓炎征象。血液培养最初表明是jeikeium棒杆菌，但由于结果不明确而被送往外部设施。外部设施将病原体鉴定为Ingnatzschineriaindica。确认结果后，抗生素被适当降低至口服左氧氟沙星.患者继续显示出临床改善，并出院，并安排了传染病的随访和每两周一次的伤口护理。考虑到美国慢性伤口的患病率越来越高，对新出现的病原体的认识和识别对于及时诊断至关重要，治疗,以及对这些复杂患者的管理。我们的案例增加了越来越多的关于由the感染伤口引起的I.inda菌血症管理的报告。
