Infection with Bacillus cereus after close-range gunshot injuries.

Three patients were admitted with close-range gunshot wounds of the knee and lower leg, inflicted in all three cases through clothing. At admission, all of the patients were given antibiotics (cefuroxime and metronidazole) to prevent streptococcal and anaerobic infection. All of the patients developed severe tissue infection with Bacillus cereus within days of admission. In one case, the organism was also recovered from the blood. B. cereus is capable of causing severe infection after trauma and its ubiquity in the environment allows it easy access to gunshot wounds. Its potent production of β-lactamase renders penicillins and cephalosporins predictably ineffective. The early administration of a non-β-lactam drug (such as ciprofloxacin) should be considered in cases where Bacillus cereus is isolated from traumatic wounds.