Bacteremia may result from ordinary activities (such as vigorous toothbrushing), dental or medical procedures, or from infections. read more, bloodstream infections Bacteremia Bacteremia is the presence of bacteria in the bloodstream. The tube that carries urine from the bladder out of the body (urethra) contains no bacteria. read more (inflammation of the membrane that lines the abdominal cavity), urinary tract infections Overview of Urinary Tract Infections (UTIs) In healthy people, urine in the bladder is sterile-no bacteria or other infectious organisms are present. The pain may be the only sign of the need for surgery. Severe abdominal pain that comes on quickly, however, almost always indicates a significant problem. read more, peritonitis Peritonitis Abdominal pain is common and often minor. Pneumonia is one of the most common causes of death worldwide. Her interests include infectious disease histology, process and quality improvement, and resident education.Gram-negative bacteria can cause many serious infections, such as pneumonia Overview of Pneumonia Pneumonia is an infection of the small air sacs of the lungs (alveoli) and the tissues around them. She is certified by the American Board of Pathology in Anatomic and Clinical Pathology as well as Medical Microbiology. Lisa Stempak, MD is the System Director of Clinical Pathology at University Hospitals Cleveland Medical Center in Cleveland, Ohio. Karla Perrizo, MD, is a Clinical Pathology resident at the University of Mississippi Medical Center. He was switched to TMP-SMX and underwent additional surgical procedures to wash out the infected area. In the case of our patient, susceptibility testing was performed on the Vitek2 instrument and the isolate was susceptible to TMP-SMX. In the case TMP-SMX resistance, ceftazidime, minocycline, ticarcillin-clavulanate, ciprofloxacin, and levofloxacin can be tested. maltophilia infections however, resistance can develop. Trimethoprim-sulfamethoxazole (TMP-SMX) is the antibiotic of choice to treat S. Beta-lactam resistance is due to two beta-lactamases and renders beta-lactam inhibitors ineffective. maltophilia is intrinsically resistant to many broad-spectrum antibiotics, including carbapenems and aminoglycosides. Current automated identification systems and MALDI-TOF mass spectrometry are able to accurately identify S. maltophilia is motile and is able to utilize glucose and maltose by oxidative fermentation. This organism is catalase and oxidase negative and DNase positive. maltophilia is characterized as an aerobic, Gram-negative rod that grows as lavender-green colonies on blood agar (Image 1) and has an ammonia-like odor. Those who are immunocompromised or have cystic fibrosis are also at an increased risk. maltophilia can readily be isolated from hospital surfaces and those with traumatic injuries, prolonged hospitalizations, on mechanical ventilation, and with in-dwelling devices are more susceptible to nosocomial infections by this organism. Stenotrophomonas maltophilia is a common non-fermenting gram negative rod that is ubiquitous in moist environments but is not commonly a member of human flora. MALDI-TOF mass spectrometry identified the isolate as Stenotrophomonas maltophilia from the wound culture. Gram stain from the blood agar plate showed gram negative rods (100x, oil immersion). Clear, lactose-negative colonies on MacConkey agar (48 hours of incubation in CO2). The wound culture grew lavender-green colonies on blood agar (48 hours of incubation in CO2). The trauma service ordered blood and wound cultures. After 10 days in the hospital and multiple surgeries to care for the wound, the patient developed a fever and increased pain, erythema, and swelling at surrounding the wound. The wound was irrigated at the bedside and the patient was admitted with a plastic surgery consult for wound coverage. His pulses were intact and motor & sensory nerve function were preserved. He sustained extensive trauma to his right lower leg with a large, dirty laceration and grossly exposed muscle. A male teenager presented to the emergency department following a 4 wheeler accident.
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