gms | German Medical Science

18th Symposium on Infections in the Immunocompromised Host

International Immunocompromised Host Society

15. to 17.06.2014, Berlin

Cellulitis of Carbapenem Resistant Pseudomonas Aeruginosa in Neutropenic Patient

Meeting Abstract

  • G. Ozgur - Turkey
  • G. Mert - GATA Infectious Diseases and Clinical Microbiology, Ankara, Turkey
  • I. Erturk - Turkey
  • F. Avcu - Turkey
  • O. Nevruz - Turkey
  • K. Kaptan - Turkey
  • T. Çetin - Turkey

18th Symposium on Infections in the Immunocompromised Host. Berlin, 15.-17.06.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14ichs22

doi: 10.3205/14ichs22, urn:nbn:de:0183-14ichs227

Veröffentlicht: 3. Juni 2014

© 2014 Ozgur et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: Pseudomonas aeruginosa which could cause life-threatening hospital-acquired infections as severe cellulitis in especially immunocompromised patients is gram negative bacillus. It is feared pathogen due to antibiotic selection difficulties related to antibiotic resistance. We presented a case of cellulitis causing carbapenem resistant pseudomonas aeruginosa which occurred on face of febrile neutropenic patient followed with acute lymphoblastic leukemia (ALL).

Results: 22 years old female patient have followed our clinic with ALL and have received chemotherapy protocol GRE-ALL. After 11 days receiving late intensification therapy, her body temperature was 38,7ºC, white blood cells were 200/mm³, neutrophils were 0/mm³. Therefore, blood and urine cultures were taken with the diagnosis of febrile neutropenia. Piperacillin-tazobactam was started as empirical treatment, but fever persisted through 72 hours, and teicoplanin was added to treatment. After the diagnosis of febrile neutropenia on sixth day, lesion was determined with fever in the right submandibular region. It was painful by palpation, 2-3 cm indurated and spreaded right buccal and periorbital (Figure1 [Fig. 1]). Because of continuing fever, piperacillin-tazobactam was switched to meropenem. On physical examination, 1 cm ulcerated necrotic lesions on the upper anterior gingiva and gingivostomatitis were detected (Figure 2 [Fig. 2]). Paranasal sinus CT scan was normal. Because of continuing fever during previous treatment, teicoplanin was stopped and daptomycin, liposomal amphotericin B was initiated. Then carbapenem-resistant Pseudomonas aeruginosa was detected in swab culture taken from lesion. It was piperacillin susceptible. Piperacillin-tazobactam, daptomycin and sulbactam for addictive effect on possible mix infection were implemented in the new treatment. Skin lesions were significantly improved during follow-up, and the fever was under control. After the lesion completely regressed, antibiotics were discontinued.

Conclusion: Carbapenems resistance was observed in 40% Pseudomonas aeruginosa strains. The carbapenem resistance that carbapenems are the last chance for life-threatening infections by multidrug resistance gram negative bacteria is very important. Cellulitis of Pseudomonas aeruginosa in febrile neutropenic patients may occur, but it is quite rare. Recently increased carbapenem-resistant Pseudomonas aeruginosa infections may cause atypical located serious infections in febrile neutropenic patients, so this should be noted. In our case, having carbapenem resistance and receiving the response to treatment after adding sulbactam are important possible undetectable mix infections especially in atypical location.

Key words: Carbapenem resistance, Pseudomonas aeruginosa, Febrile Neutropenia