title: Biliary infection and bacteremia caused by beta-lactamase-positive, ampicillin-resistant Haemophilus influenzae in a diabetic patient.
abstract: We report the case of a 73-year-old female patient with diabetic nephropathy and cholelithiasis. She was admitted to our hospital with right upper abdominal pain, nausea, and vomiting. The patient had visited an outpatient clinic with the same complaints 2 days earlier, and had been prescribed antibiotics empirically (two doses ofloxacin orally). Blood cultures taken before the start of antibiotic treatment in our hospital were negative. The patient was treated with parenteral ampicillin/sulbactam + ciprofloxacin empirically. The empiric antibiotic treatment was discontinued after 7 days. Elective cholecystectomy was performed after her general condition improved. An aerobic chocolate agar culture of the cholecystectomy material yielded Haemophilus influenzae type b. On postoperative day 3 the patient developed fever again. The fluids collected after cholecystectomy were evaluated microbiologically. H. influenzae type b was isolated from the samples and blood cultures. The patient was diagnosed with H. influenzae cholecystitis, and recovered after 10-day treatment with ampicillin/sulbactam + ciprofloxacin. The findings are discussed together with references for differential diagnosis. H. influenzae cholecystitis due to cholelithiasis, although rare, should be considered in elderly patients with a history of chronic diseases such as diabetes mellitus or nephropathy.
authors.affiliation: Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Abant Izzet Baysal University, Duzce 81100, Turkey. sukruoksuz@hotmail.com
authors.forename: Sukru
authors.initials: S
authors.lastname: Oksuz
authors.forename: Elif
authors.initials: E
authors.lastname: Ozturk
authors.forename: Idris
authors.initials: I
authors.lastname: Sahin
authors.forename: Osman
authors.initials: O
authors.lastname: Ertor
authors.forename: Demet
authors.initials: D
authors.lastname: Kaya
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology*; D001660:Biliary Tract Diseases / Q000188:drug therapy / Q000382:microbiology*; D003920:Diabetes Mellitus; D005260:Female; D006192:Haemophilus Infections / Q000188:drug therapy / Q000382:microbiology*; D006193:Haemophilus influenzae / Q000201:enzymology* / Q000235:genetics*; D006801:Humans; D010403:Penicillin Resistance; D001618:beta-Lactamases / Q000302:isolation & purification*
chemical_list: D001618:beta-Lactamases