So I'm on rotations right now. Fourth year!! I didn't think I would make it. I was very close to failing the last semester of therapy due to my inability to learn antimicrobials and their appropriate regimens.
So of course I'm about to finish up an Antimicrobial Stewardship rotation.
Things have been rather...general the first 3.5 weeks of the rotation. Then last Wednesday a patient came in with large leg swelling and turning purple/black. They were in sepsis. They had cut themselves on Sunday and had gotten a prescription for Keflex. However, the cut had progressed into an infection. By the time they had gotten to the hospital we threw Primaxin, Zyvox, clindamycin, and Levaquin at them, due to the quick progression. The discoloration and swelling had moved up toward the hip area.
We couldn't transfer them to a different hospital, one more equipped for this type of issue. So we arranged for an amputation, which was successful, but unfortunately the patient was in such poor condition that they passed away. The surgeon said that the leg had pockets of fluid and gas that smelled horrible, and that the muscle had turned into mush. It was also possible that the gangrene had progressed to the lower back region.
It shook everyone up in the pharmacy and Infectious Disease department, especially since the patient passed away within 24 hours of arrival to the hospital. I've thought about that patient every day.
The cultures came back with Proteus vulgaris, Klebsiella, and Aeromonas. Aeromonas loves to live in water and is a rather sensitive microbe, but specific in what you can treat it with. I've found that Bactrim, 3rd and 4th generation cephalosporins, and the quinolones are effective in treating it. Antibiotics that are commonly prescribed in the healthcare community.
Anyway, another patient, this time a 10 year old came in on Monday with the same presentation. The culture came back today (Wednesday) positive for Aeromonas. I hope it all works out, and I will definitely check on their progress.
It was by good happenstance that the Infectious Disease physician was alerted to the patient and recognized the similar progression and ordered the culture, as well as started them on appropriate antibiotics.
I like to think that the previous patient would be somewhat glad that their infection last week was able to alert us to potentially save a 10 year old. I'll probably continue to think about these cases for a long time to come.