Enterobacter asburiae and Aeromonas hydrophila: soft tissue infection requiring debridement

Orthopedics. 2012 Jun;35(6):e996-9. doi: 10.3928/01477447-20120525-52.

Abstract

Enterobacter asburiae and Aeromonas hydrophila are gram-negative bacilli that have been isolated in soil and water. Enterobacter asburiae can cause an array of diseases, and exposure to A hydrophila can cause soft tissue infections, including necrotizing faciitis.A healthy-appearing 22-year-old man presented with an innocuous soft tissue injury to his leg due to an all-terrain vehicle crash. He received intravenous antibiotics and was discharged with prophylactic oral antibiotics. After the rapid onset of high fevers (102°F-103°F) <24 hours postinjury, he returned to the emergency department. Emergent surgical debridement was performed, and broad-spectrum intravenous antibiotics were started. Fevers persisted, and the patient underwent repeat extensive surgical debridement and antibiotic bead placement <30 hours after the initial surgical debridement and broad-spectrum antibiotics. Intraoperative cultures found E asburiae and A hydrophila in the wound. Following a long course of antibiotics and a skin graft, he fully recovered and had no functional deficits 1 year postoperatively.Extensive research revealed that these organisms are rare in soft tissue infections. E asburiae is opportunistic but has not been reported as a primary wound organism, and A hydrophila infections have been reported following motor vehicle crashes involving wound contamination. At presentation, it is challenging to determine rare organisms in a timely fashion; however, emergent extensive surgical intervention of an accelerated aberrant disease process should be considered to avoid catastrophic outcomes.

Publication types

  • Case Reports

MeSH terms

  • Aeromonas hydrophila*
  • Anti-Bacterial Agents / therapeutic use*
  • Combined Modality Therapy
  • Debridement / methods*
  • Enterobacter*
  • Gram-Negative Bacterial Infections / therapy*
  • Humans
  • Male
  • Soft Tissue Infections / therapy*
  • Treatment Outcome
  • Young Adult

Substances

  • Anti-Bacterial Agents