Biliary infection and bacteremia caused by beta-lactamase-positive, ampicillin-resistant Haemophilus influenzae in a diabetic patient.
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.
Oksuz
Sukru
S
Department of Microbiology and Clinical Microbiology, Faculty of Medicine, Abant Izzet Baysal University, Duzce 81100, Turkey. sukruoksuz@hotmail.com
Ozturk
Elif
E
Sahin
Idris
I
Ertor
Osman
O
Kaya
Demet
D
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*
D001618:beta-Lactamases