Enterobacter asburiae and Aeromonas hydrophila: Soft Tissue Infection Requiring Debridement

Full article available online at Healio.com/Orthopedics. Search: 20120525-52 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. Drs Koth and Boniface and Ms Hanes are from the Department of Orthopedics, and Ms Chance is from the Trauma Services Department, St Elizabeth Health Center, Youngstown, Ohio. Drs Koth and Boniface and Mss Chance and Hanes have no relevant financial relationships to disclose. The authors thank Barbara Hileman, BA, from the Trauma Research Department at St Elizabeth Health Center for her assistance with editing, and Aurelia Buzulencia, MT, in the Microbiology Department at St Elizabeth Health Center for providing microbiology incidence numbers. Correspondence should be addressed to: Kevin Koth, DO, Department of Orthopedics, St Elizabeth Health Center, 1044 Belmont Ave, Youngstown, OH 44501 (kothkg@gmail.com). doi: 10.3928/01477447-20120525-52 Enterobacter asburiae and Aeromonas hydrophila: Soft Tissue Infection Requiring Debridement Kevin Koth, Do; James Boniface, mD; elisha a. chance, Bsas; marina c. hanes, Ba