Abstract
Alcaligenes faecalis is a gram-negative bacterium that is commonly found in the environment. This pathogen is usually transmitted in the form of droplets through ventilation equipment and nebulizers, but transmission through direct contact has also been documented in few case reports. This pathogen can cause rare but fatal infections including appendicitis, abscesses, meningitis, bloodstream infection, endocarditis, and post-operative endophthalmitis. Pan drug resistance to all commercially available antibiotics has been emerging globally. We present the case of a 66-year-old male who had respiratory failure along with multiple comorbidities. A large cavitary lesion caused by pan drug-resistant Alcaligenes faecalis was found on chest imaging. Despite the treatment with broad-spectrum antibiotics, the clinical outcome was very poor.
Highlights
A rod-shaped and gram-negative bacterium that is commonly found in the environment has a species named Alcaligenes faecalis
After admitting the patient to the medical intensive care unit (MICU), he was given broad-spectrum antibiotic while waiting for the culture results to treat sepsis that was possibly secondary to gram-negative/methicillin-resistant Staphylococcus aureus pneumonia
Three species are included in the genus Alcaligenes namely Alcaligenes faecalis, Alcaligenes xylosoxidans, and Alcaligenes piechaudii
Summary
A rod-shaped and gram-negative bacterium that is commonly found in the environment has a species named Alcaligenes faecalis. After admitting the patient to the medical intensive care unit (MICU), he was given broad-spectrum antibiotic while waiting for the culture results to treat sepsis that was possibly secondary to gram-negative/methicillin-resistant Staphylococcus aureus pneumonia. The patient’s respiratory status kept declining while awaiting results of the sputum culture and sensitivity, and heavy gram-negative bacillus was observed in the preliminary respiratory culture. The patient was started on polymyxin B three days later after the official sputum culture, and sensitivity report indicated the presence of A. faecalis. On the basis of multiple irregular nodules shown on the chest CT scan, three sputum cultures were sent, which returned negative for acid-fast bacilli. The patient’s condition worsened and he died despite the aggressive antibiotic treatment
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