Wound erysipelas following appendectomy caused by group B beta-hemolytic Streptococcus (Streptococcus agalactiae).
BACKGROUND
Case description of a patient who developed erysipelas of the surgical wound following appendectomy for acute appendicitis, and literature review of invasive group B streptococcal infections.


METHODS
A 65-year-old man with perforated appendicitis underwent urgent appendectomy and drainage. Antibiotic prophylaxis with tobramycin (100 mg) and metronidazole (500 mg) was administered. At surgery, a phlegmon was identified with free perforation of the appendix and purulent peritoneal fluid. Appendectomy, irrigation with 0.9% NaCl solution, and drainage with a Silastic closed-suction drain was performed. A literature search in all languages was performed using MEDLINE, using the search terms surgical site infection, wound infection, group B streptococcus, Streptococcus agalactiae, necrotizing fasciitis, and postoperative infection.


RESULTS
Erysipelas of the surgical wound developed on the fourth postoperative day. Intravenous penicillin and amoxicillin/clavulanic acid were administered empirically. Culture of the wound drainage identified Streptococcus agalactiae and a few colonies of Escherichia coli. The broad-spectrum antibiotic was discontinued, and a 10-day course of penicillin was completed.


CONCLUSIONS
Erysipelas of the surgical wound is unusual, and infection with group B streptococci is rare compared with infection by group A streptococci. Streptococcus agalactiae is recognized to be increasingly virulent, with an increasing predilection for bacteremic infections in healthy hosts. Although Streptococcus agalactiae remains highly susceptible to antimicrobial agents effective against gram-positive cocci, the changing epidemiology and potentially invasive nature of these infections should have clinicians alert to the possibility of infection caused by group B streptococci.
Caínzos
M
M
Department of Surgery, Hospital Clinico Universitario, Universidad de Santiago de Compostela, Santiago de Compostela, Spain. ci28@usc.es
Hindi
E Y
EY
Fernandez
F
F
Rodriguez-Segade
F
F
Ferandez
A
A
Potel
J
J
D000368:Aged; D001062:Appendectomy / Q000009:adverse effects*; D004886:Erysipelas / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D008297:Male; D013292:Streptococcus agalactiae; D013530:Surgical Wound Infection / Q000382:microbiology* / Q000628:therapy