Ampicillin/sulbactam/vancomycin Reactions 1680, p32 - 2 Dec 2017 Febrile episodes in an elderly: case report A 67-year-old woman developed several febrile episodes while receiving ampicillin/sulbactam and vancomycin for Robinsoniella peoriensis infection related to right femoral hardware. The woman, who had history of chronic kidney disease and hypertension, had undergone distal femur open reduction internal fixation (ORIF) due to right femur fracture in December 2015. Despite revision of ORIF on 20 January 2016, signs of nonunion of the femur, and a fractured rod were noted on radiographic studies in July 2016. She was hospitalised on 17 August 2016 due to hardware failure and a non healing abscess distal to the incision with profuse purulent fluid. Prior to hospitalisation, she was treated with three different antibiotics. She underwent right femur deep hardware removal and debridement of deep tissue and bone. Seven cultures at multiple sites along the femur bone, hardware plate and tissues surrounding the hardware were obtained. She had no fever on admission and exhibited a WBC count of 11 300 cells/mm , CRP of 7.3 mg/L, and ESR of 6 mm/h. On day one of admission, vancomycin was started and adjusted by serum trough levels accordingly. On hospital day 5, IV ampicillin/sulbactam 3g every six hours was started. Six out of the seven cultures obtained were all positive for Robinsoniella peoriensis identified by the 16S ribosomal RNA sequencing. She had several febrile episodes with a maximum temperature of 101.1°F on day seven of hospitalisation. Tachycardia developed during the febrile episodes. Initially, the episodes of fever were suspected to be due to treatment failure or drug induced fever. However, due to a lack of leukocytosis the fever was considered as drug-induced. Antimicrobials were changed to ertapenem and the woman was discharged on day eight after the fevers resolved. Subsequently, she was followed-up in an outpatient setting. Author comment: "The patient spiked multiple fevers after one week of ampicillin/sulbactam and vancomycin. It is unclear if this was due to treatment failure or drug induced fever. Drug fever seemed conceivable due to a lack of leukocytosis although the patient did become tachycardic during the febrile episode." Schmetterer J, et al. Robinsoniella peoriensis infection related to right femoral hardware. IDCases 10: 115-116, 11 Oct 2017. Available from: URL: http:// - USA 803284417 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680 Reactions Weekly Springer Journals


Reactions Weekly , Volume 1680 (1) – Dec 2, 2017
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Springer International Publishing
Copyright © 2017 by Springer International Publishing AG, part of Springer Nature
Medicine & Public Health; Drug Safety and Pharmacovigilance; Pharmacology/Toxicology
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