Wissam K Kabbara1, Yara R Zgheib2. 1. Wissam K. Kabbara, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice; and Yara R. Zgheib, B.S.Pharm., is Pharm.D. student, School of Pharmacy, Lebanese American University, Byblos, Lebanon. wissam.kabbara@lau.edu.lb. 2. Wissam K. Kabbara, Pharm.D., BCPS, is Clinical Assistant Professor, Department of Pharmacy Practice; and Yara R. Zgheib, B.S.Pharm., is Pharm.D. student, School of Pharmacy, Lebanese American University, Byblos, Lebanon.
Abstract
PURPOSE: The case of a diabetic foot infection caused by Raoultella ornithinolytica is reported. SUMMARY: A 68-year-old Caucasian man arrived at the hospital with a fever (38.5 °C) and a foul-smelling pressure ulcer on his left foot and was admitted for treatment of a moderate diabetic foot infection. The patient's medical history included type II diabetes mellitus, hypertension, chronic kidney disease, dyslipidemia, cataract surgery, and total hip arthroplasty. A tissue biopsy of the diabetic foot lesion was performed, and a blood sample was cultured. Empirical antimicrobial treatment consisting of amoxicillin-clavulanate 1.2 g (of amoxicillin) i.v. every 12 hours and ciprofloxacin 200 mg i.v. every 12 hours was initiated to target aerobic gram-positive and gram-negative and anaerobic microorganisms. After 48 hours, the results of the blood culture were negative, but the left ankle wound culture grew R. ornithinolytica. Although the isolated R. ornithinolytica was relatively sensitive, showing resistance only to cefazolin and ampicillin, the antibiotic regimen was not changed. The patient showed clinical and laboratory improvement during his 5-day hospitalization. Subsequently, i.v. antibiotics were discontinued, and the patient was discharged on oral amoxicillin-clavulanate 1 g (of amoxicillin) twice daily and oral ciprofloxacin 750 mg twice daily for an additional 9 days to complete a total duration of 14 days of treatment, after which the infection was completely resolved. CONCLUSION: A 68-year-old man diagnosed with a diabetic foot infection caused by R. ornithinolytica was successfully treated with amoxicillin-clavulanate and ciprofloxacin.
PURPOSE: The case of a diabetic foot infection caused by Raoultella ornithinolytica is reported. SUMMARY: A 68-year-old Caucasian man arrived at the hospital with a fever (38.5 °C) and a foul-smelling pressure ulcer on his left foot and was admitted for treatment of a moderate diabetic foot infection. The patient's medical history included type II diabetes mellitus, hypertension, chronic kidney disease, dyslipidemia, cataract surgery, and total hip arthroplasty. A tissue biopsy of the diabetic foot lesion was performed, and a blood sample was cultured. Empirical antimicrobial treatment consisting of amoxicillin-clavulanate 1.2 g (of amoxicillin) i.v. every 12 hours and ciprofloxacin 200 mg i.v. every 12 hours was initiated to target aerobic gram-positive and gram-negative and anaerobic microorganisms. After 48 hours, the results of the blood culture were negative, but the left ankle wound culture grew R. ornithinolytica. Although the isolated R. ornithinolytica was relatively sensitive, showing resistance only to cefazolin and ampicillin, the antibiotic regimen was not changed. The patient showed clinical and laboratory improvement during his 5-day hospitalization. Subsequently, i.v. antibiotics were discontinued, and the patient was discharged on oral amoxicillin-clavulanate 1 g (of amoxicillin) twice daily and oral ciprofloxacin 750 mg twice daily for an additional 9 days to complete a total duration of 14 days of treatment, after which the infection was completely resolved. CONCLUSION: A 68-year-old man diagnosed with a diabetic foot infection caused by R. ornithinolytica was successfully treated with amoxicillin-clavulanate and ciprofloxacin.