rss
BMJ Case Reports 2014; doi:10.1136/bcr-2014-207200
  • CASE REPORT

Multidrug-resistant Escherichia coli soft tissue infection investigated with bacterial whole genome sequencing

  1. Ian C J W Bowler1
  1. 1Department of Microbiology and Infectious Diseases, Oxford University Hospitals, Oxford, UK
  2. 2Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
  1. Correspondence to Dr Ruaridh Buchanan, ruaridhbuchanan{at}doctors.org.uk
  • Accepted 28 September 2014
  • Published 19 October 2014

Summary

A 45-year-old man with dilated cardiomyopathy presented with acute leg pain and erythema suggestive of necrotising fasciitis. Initial surgical exploration revealed no necrosis and treatment for a soft tissue infection was started. Blood and tissue cultures unexpectedly grew a Gram-negative bacillus, subsequently identified by an automated broth microdilution phenotyping system as an extended-spectrum β-lactamase producing Escherichia coli. The patient was treated with a 3-week course of antibiotics (ertapenem followed by ciprofloxacin) and debridement for small areas of necrosis, followed by skin grafting. The presence of E. coli triggered investigation of both host and pathogen. The patient was found to have previously undiagnosed liver disease, a risk factor for E. coli soft tissue infection. Whole genome sequencing of isolates from all specimens confirmed they were clonal, of sequence type ST131 and associated with a likely plasmid-associated AmpC (CMY-2), several other resistance genes and a number of virulence factors.

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog

Navigate This Article