A Rare Surgical Site Infection from Cedecea lapagei
Location
D.P. Culp Center Ballroom
Start Date
4-5-2024 9:00 AM
End Date
4-5-2024 11:30 AM
Poster Number
56
Name of Project's Faculty Sponsor
Harsha Vedantam
Faculty Sponsor's Department
Internal Medicine
Competition Type
Competitive
Type
Poster Presentation
Presentation Category
Health
Abstract or Artist's Statement
Surgical site infections (SSI) remains an important source of morbidity and mortality despite improvements in strategies for prevention. They account for 20% of all hospital acquired infections and are associated with 2-11 fold increase in risk of mortality [1,2]. Although the causative organism depends on type of procedure, most of the time they originate from patient’s local commensal flora. The most commonly isolated organisms are Staphylococcus, Streptococcus, Enterobacteriaceae and Enterococcus. Here we present the case of a 47 year old male patient who had a post operative wound infection growing Cedecea lapagei (CL). Although there are isolated case reports of this gram-negative bacillus causing pneumonia and traumatic wound infections, to our knowledge this is the first reported case of SSI due to this organism. 47-year-old male was referred to emergency department by out-patient orthopedic surgery after intraoperative tissue culture from irrigation and debridement of left proximal tibia resulted positive for CL. Pathological antecedents include hyperlipidemia, atrial fibrillation, and self-inflicted left lower extremity gunshot wound status post external fixation and subsequent open reduction internal fixation. He continued to have wound complication involving swelling and open, draining skin pocket. Seven months after initial procedure for an area of discoloration near the surgical site. He was prescribed one week of trimethoprim/sulfamethoxazole without significant improvement. On re-evaluation by his orthopedic specialist, cystic fluid collection was noted. He then underwent I&D and post-operatively was placed on doxycycline. Intra-operative cultures then resulted positive for CL. On initial presentation to ED, an incisional wound at the proximal lateral tibia with slight erythema and crusting was noted. Erythema appeared consistent with appropriate stage of healing. No fevers, chills, pain, warmth or color change at the site were reported. ID was consulted. Tissue culture and gram stain obtained from soft tissue debridement revealed light growth of CL. Although it was not determined to be pathogenic until 2006, CL has been reported to cause soft tissue infection with multiple hemorrhagic bullae [3]. Due to this feared outcome, it is important to recognize this organism as a rare, but, potentially fatal pathogen in SSI. Choice of antibiotic regimen should be tailored to culture sensitivities, but generally avoid ampicillin as there is a higher incidence of resistance [4]. For this patient, ceftriaxone was selected due to its broader and stronger gram-negative coverage compared with early generation cephalosporins as well as its good antimicrobial activity against multi-drug resistant Enterobacteriaceae. Expanding on current literature on known SSI pathogens, this case illustrates a rare SSI caused by CL.
A Rare Surgical Site Infection from Cedecea lapagei
D.P. Culp Center Ballroom
Surgical site infections (SSI) remains an important source of morbidity and mortality despite improvements in strategies for prevention. They account for 20% of all hospital acquired infections and are associated with 2-11 fold increase in risk of mortality [1,2]. Although the causative organism depends on type of procedure, most of the time they originate from patient’s local commensal flora. The most commonly isolated organisms are Staphylococcus, Streptococcus, Enterobacteriaceae and Enterococcus. Here we present the case of a 47 year old male patient who had a post operative wound infection growing Cedecea lapagei (CL). Although there are isolated case reports of this gram-negative bacillus causing pneumonia and traumatic wound infections, to our knowledge this is the first reported case of SSI due to this organism. 47-year-old male was referred to emergency department by out-patient orthopedic surgery after intraoperative tissue culture from irrigation and debridement of left proximal tibia resulted positive for CL. Pathological antecedents include hyperlipidemia, atrial fibrillation, and self-inflicted left lower extremity gunshot wound status post external fixation and subsequent open reduction internal fixation. He continued to have wound complication involving swelling and open, draining skin pocket. Seven months after initial procedure for an area of discoloration near the surgical site. He was prescribed one week of trimethoprim/sulfamethoxazole without significant improvement. On re-evaluation by his orthopedic specialist, cystic fluid collection was noted. He then underwent I&D and post-operatively was placed on doxycycline. Intra-operative cultures then resulted positive for CL. On initial presentation to ED, an incisional wound at the proximal lateral tibia with slight erythema and crusting was noted. Erythema appeared consistent with appropriate stage of healing. No fevers, chills, pain, warmth or color change at the site were reported. ID was consulted. Tissue culture and gram stain obtained from soft tissue debridement revealed light growth of CL. Although it was not determined to be pathogenic until 2006, CL has been reported to cause soft tissue infection with multiple hemorrhagic bullae [3]. Due to this feared outcome, it is important to recognize this organism as a rare, but, potentially fatal pathogen in SSI. Choice of antibiotic regimen should be tailored to culture sensitivities, but generally avoid ampicillin as there is a higher incidence of resistance [4]. For this patient, ceftriaxone was selected due to its broader and stronger gram-negative coverage compared with early generation cephalosporins as well as its good antimicrobial activity against multi-drug resistant Enterobacteriaceae. Expanding on current literature on known SSI pathogens, this case illustrates a rare SSI caused by CL.