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0196-4399/00 (see frontmatter) © 2008 Elsevier Clinical Microbiology Newsletter 30:16,2008
Introduction
Alcaligenes faecalis is frequently
found in the feces of healthy people,
and systemic infections appear to be
uncommon. Nevertheless, if the organ-
ism is cultured from blood, it should not
be dismissed as a contaminant without
careful investigation. Here, we report a
patient with bacteremia caused by an
extended-spectrum β-lactamase (ESBL)-
producing A. faecalis strain. A possible
cause was translocation of the microor-
ganism during colonoscopy. Although
the strain was an ESBL producer, the
patient clinically recovered following
amoxicillin-clavulanate therapy.
Case Report
An 86-year-old woman with Alz-
heimer’s disease was admitted to the
intensive care unit with acute respira-
tory distress and abdominal distention.
In recent years, she had been hospital-
ized twice for fecal impaction. On
admission, she was intubated and
mechanically ventilated. She was
hemodynamically stable, gas exchange
was well preserved, and renal function
was maintained. Her temperature on
admission was 37.6°C. Her abdomen
was distended and tender, with dimin-
ished bowel sounds. Laboratory analy-
sis revealed a leukocyte count of 11 x
10
9
/L (77% neutrophils), a C-reactive
protein concentration of 0.67 mg/dl,
hemoglobin of 13.1 g/dl, blood urea
nitrogen of 67 mg/dl, creatinine of
0.56 mg/dl, and elevated liver enzymes
(aspartate transaminase of 74 IU/L,
alanine transaminase of 82 IU/L, and
γ-glutamyl transferase of 63 U/L).
Because a chest X ray showed bilat-
eral infiltrates, a diagnosis of commu-
nity-acquired pneumonia was made.
An endotracheal aspirate was sent for
culture, and therapy with intravenous
amoxicillin-clavulanate was started.
A CT scan of the abdomen revealed a
marked distention of the entire colon
without signs of obstruction. Subse-
quently, colonoscopy was performed,
which confirmed the diagnosis of
Mailing Address: Reinout Naesens, M.D.,
Laboratory of Microbiology, GZA Sint-
Augustinus, Oosterveldlaan 24, 2610
Wilrijk Belgium. Tel.: 0032/11 22 17 49.
Fax: 0032/51 21 15 86. E-mail:
reinoutnaesens@hotmail.com
Case Report
Bacteremia Caused by an Extended-Spectrum Beta-Lactamase-
Producing Alcaligenes faecalis Strain
R. Naesens, M.D.,
1
J. Van Leemput, M.D.,
2
J. Raemaekers, M.D.,
2
J. Van Schaeren, M.D.,
1
and A. Jeurissen, M.D., Ph.D.
1
1
Department of Microbiology,
2
Department of Intensive Care Medicine, GZA Sint-Augustinus, Wilrijk, Belgium