Monday, May 9, 2011

Mike and Ike

You are doing home visits and stumble upon this scene. The patient admits to doing IM shots of street drugs. "But it's cool, I clean the needle before I inject." You ask him how he cleans the needle and he says, "I lick it." Unfortunately, he has an erythematous tender area over his deltoid where he injects. "I think I might have an infection," he says. You admit him to the hospital and get an ultrasound which shows a complex fluid collection. Aspiration shows gram negative rods. Unfortunately at that time, he says, "I want to leave. I'm not going to stay. Just give me some oral antibiotics."

Challenge: What is the antibiotic of choice here? What might the organism be?

Image is in the public domain, from Wikipedia.


Michelle said...

bacteroides sp.?

Craig Chen said...

bacteroides could certainly be possible (though for anaerobes, the mouth is more concerning for peptostreptococcus). here, i was going for eikenella.
Mike and Ike

Unfortunately, this needs to be treated as a polymicrobial infection of mouth flora; the gram negative rod most likely represented Eikenella corrodens. The antibiotic choice here would be amoxicillin-clavulanate.

Source: UpToDate.