SUCCESSFUL TREATMENT OF MULTIDRUG-RESISTANT ACINETOBACTOR BAUMANII BLISTERS ON THE KNEE
AbstractAcinetobacter baumannii (A. baumannii), nosocomial infections, especially those due to multi-drug resistant (MDR) strains, are increasingly detected. This study reports the case of a 50 year old man with blisters on the right knee for 8 months, first admitted through the outpatient department for incisional biopsy. Microbiological and histo-pathological examination confirmed the diagnosis of blisters extending deeply up to the knee joint caused by MDR- A. baumannii. A broad spectrum antibiotic therapy was administered and later readjusted according to the results of microbiological culture and biopsy report. Intensive hemodynamic support was required. An extensive surgical debridement was promptly performed and repeated until complete control of the infection with intravenous colistins. Blisters were excised; wounds were dressed daily with chlorhexidine dressings and polymyxine-impregnated dressing. Wounds were finally covered with split-thickness skin grafts. The infection was overcome 120 days after admission. The graft take was 40%. Postoperative rehabilitation was required because of the functional limitation of lower limb movements at the knee joint. Follow-up at 8 months showed no functional deficit and an acceptable aesthetic result. AB-MDR affecting soft tissues is a life-threatening disease, especially in patients with poor immunity and limited access to health facilities, whose clinical diagnosis may sometimes be challenging. Early recognition and treatment represent the most important factors influencing survival.Keywords: Acinetobacter baumannii, Colistin, Chlorhexidine
Bergogne-Berezin E, Towner KJ. Acinetobacter spp. as nosocomial pathogens: Microbiological, clinical and epidemiology features. Clin Microbiol Rev 1996;9(2):148–65.
Joshi SG, Litake GM, Niphadkar KB, Ghole VS. Multidrug resistant Acinetobacter baumannii isolates from a teaching hospital. J Infect Chemother 2003;9(2):187–90.
Maltezou HC. Metallo-beta-lactamases in Gram-negative bacteria: Introducing the era of pan-resistant? Int J Antimicrob Agents 2009;33(5):405.e1–7.
Mirza IA, Hussain A, Abbasi SA, Malik N, Satti L, Farwa U. Ambu bag as a source of Acinetobacter baumannii outbreak in an intensive care unit. J Coll Physicians Surg Pak 2011;21(3):176–8.
Morioka H, Matsumoto S, Kojima E, Takada K, Shizu M, Okachi S. A case of fulminant community-acquired Acinetobacter pneumonia in a healthy woman. Nihon Kokyuki Gakkai Zasshi 2011 Jan;49(1):57–61.
Sullivan DR, Shields J, Netzer G. Fatal case of multi-drug resistant Acinetobacter baumannii necrotizing fasciitis. Am Surg 2010;76(6):651–3.
De Pascale G, Pompucci A, Maviglia R, Spanu T, Bello G, Mangiola A, et al. Successful treatment of multidrug-resistant Acinetobacter baumannii ventriculitis with intrathecal and intravenous colistin. Minerva Anestesiol 2010;76(11):957–60.
Tekçe AY, Erbay A, Çabadak H, Yagcı S, Karabiber N, Şen S. Pan-resistant Acinetobacter baumannii mediastinitis treated successfully with tigecycline: a case report. Surg Infect (Larchmt) 2011;12(2):141–3.
Nagashima G, Uchida K, Takada T, Ueda T, Tanaka Y, Hashimoto T, et al. A case of post-operative cerebral abscess caused by multidrug-resistant Acinetobacter baumannii-possibly originating abroad, and poorly susceptible to colistin. No Shinkei Geka 2012;40(2):151–7
Telang NV, Satpute MG, Dhakephalkar PK, Niphadkar KB, Joshi SG. Fulminating septicemia due to persistent pan-resistant community-acquired metallo-β-lactamase (IMP-1)-positive Acinetobacter baumannii. Indian J Pathol Microbiol 2011;54(1):180–2.
Charnot-Katsikas A, Dorafshar AH, Aycock JK, David MZ, Weber SG, Frank KM. Two cases of necrotizing fasciitis due to Acinetobacter baumannii. J Clin Microbiol 2009;47(1):258–63.
Lowman W, Kalk T, Menezes CN, John MA, Grobusch MP. A case of community-acquired Acinetobacter baumannii meningitis - has the threat moved beyond the hospital? J Med Microbiol 2008;57:676–8.