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.

2 comments:

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.
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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.