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Multidrug-Resistant Ewingella Americana: A Case Report and Review of the Literature

Assistant Professor of Pharmacy Practice, School of Pharmacy, Campbell University, Buies Creek, NC; Cape Fear Valley Health System, Fayetteville, NC

Serina B Tart, PharmD

Infectious Diseases Clinical Pharmacist, Cape Fear Valley Health System

Obiefuna Okoye, MD MPH

Infectious Diseases Physician, Department of Infectious Diseases, Cape Fear Valley Health System

Reprints: Dr. Pound, Campbell University School of Pharmacy, PO Box 1090, Buies Creek, NC 27506, fax 910/609-5478, mpound{at}capefearvalley.com

OBJECTIVE: To describe and report a case of multidrug-resistant Ewingella americana associated with exacerbation of chronic obstructive pulmonary disease (COPD).

CASE SUMMARY: A 77-year-old female presented to her physician with shortness of breath and an initial assessment of pneumonia. Her past medical history included COPD, Mycobacterium tuberculosis infection, recent Mycobacterium avium infection, and Crohn's disease. Blood and urine cultures revealed no growth; however, a sputum culture later revealed multidrug-resistant E. americana. The patient was ultimately treated with trimethoprim/sulfamethoxazole (TMP/SMX), with complete resolution of symptoms following a 10 day course.

DISCUSSION: E. americana is a rare gram-negative bacillus that has infrequently been reported to cause infection. This organism has been reported in humans in the blood, sputum, conjunctiva, wounds, and peritoneal fluid. In several of these cases, as well as in our case, this organism appeared to occur more frequently in immunocompromised patients. Although generally susceptible to most antibiotics, our patient's organism was resistant to all antibiotics tested, with the exception of TMP/SMX, ticarcillin/clavulanate, and cefotetan.

CONCLUSIONS: To our knowledge, this is only the second case of an E. americana respiratory infection, and the only one in which multidrug resistance has been reported.

Published Online, October 23, 2007. www.theannals.com, DOI 10.1345/aph.1K398