We present the case of a patient with significant Bacillus cereus bloodstream infection. We are having some debate about the ideal targeted antibiotic therapy. Comments will be appreciated.
A continuación os presentamos un caso clínico activo, que nos está planteando dudas sobre el manejo antibiótico…todos los comentarios son bienvenidos…Un saludo
A 62 year-old man with significant past medical history for gout was admitted to our hospital 2 weeks ago because of acute pulmonary edema. On TTE he was found to have severe doble aortic damage. 48h after admission he spikes a fever of 38.5 and blood cultures were drawn (negative). 48 hours later he spikes again and new blood cultures are obtained, which grew Bacillus cereus (3/3). Concomitantly with these blood cultures he was found to have a peripheral vein phlebitis which was removed and vancomycin was started. 48 hours after starting vancomycin, he had a new fever and a new set of blood cultures was obtained (Bacillus cereus 1/3). Awaiting the susceptibility reports imipenem was added. Micro lab reports the following susceptibility data: Pen R (>8); Cefotaxime R (>16); Meropenem S (0.12); Vanc S (<1); Dapto S (4); gentamicin S(<4); clindamycin S(2)
Patient is awiting for TEE, but even if negative we consider this as a high risk bacteremia given his valve status. We have not found much information about how to treat a high risk Bacillus cereus bacteremia/endocarditis. The case has been discussed in our ID/Micro conference with a broad discrepancies: some argue in favor of combining vancomycin and gentamicin, some in favor of vancomycin in monotherapy and others in favor of including a b-lactam (carbapenem) +/- vancomycin. We would appreciate your input.
Patient has had no significant contact with Healthcare System in the previous months, nor has had recent dentalwork. No IVDU. Concomitantly he has been found to have microcitic anemia and has lost 10 pounds weight in the previous 6 months. This is going to be worked-up.
Thank you very much.
José R. Pano-Pardo
Hospital Universitario La Paz-IDIPAZ