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Background
Raoultella ornithinolytica is a rare gram-negative bacterium that is both a human commensal and free living in the environment. 1 As a group, they have been described in several aquatic and non-aquatic environments including hospital settings. 2 Pathologically, they have been associated with a limited but varied number of infections but to our knowledge, no previous reports of wound infection after breast reduction surgery has been attributable to this organism. This presentation is a case of bilateral wound infection and fat necrosis following breast reduction surgery in a young immunocompetent woman which was successfully treated with antibiotics and surgical debridement.
Case presentation
A 24-year-old woman with no significant past medical problems underwent bilateral breast reduction surgery during which 1740g and 1610g of breast tissue were removed from the right and left breasts, respectively. She initially had an uneventful postoperative course. Three weeks after her surgery, however, she reported pain and wound discharge around the nipple/areola area of both breasts. Despite treatment with oral clindamycin and daily wound care, the symptoms got worse with increasing pain, discharge, fever and chills, prompting in-patient admission approximately 4weeks from her initial surgery.
Evaluation at admission showed low-grade fever of 100.3oF, heart rate 93 beats/minute and blood pressure 111/60mm Hg. Examination of the breasts showed wound dehiscence around both nipple areolar complex with evidence of fat necrosis. The wound on the left breast appear worse compared with the right with complete destruction of the left nipple areolar complex ( figures 1 and 2 ). Wound cultures were obtained for bacterial, fungal and mycobacterial cultures, and she was started empirically on intravenous clindamycin 600mg every 8hours and ciprofloxacin 400mg intravenously every 12hours. Fungal and mycobacterial cultures were negative but bacterial cultures grew Escherichia coli, Enterococcus faecalis and R. ornithinolytica. Specifically, the R. ornithinolytica grew on routine plate media (blood, chocolate and eosin methylene blue) and was definitively identified by the MicroScan Walkway 96 plus system. All the identified pathogens were sensitive to multiple antibiotic classes, and multidrug resistance was not a significant consideration. The R. ornithinolytica was only resistant to ampicillin and trimethoprim/sulfamethoxazole but was sensitive to amikacin, cefazolin, cefotaxime, ceftriaxone, ciprofloxacin, levofloxacin and gentamicin.
Investigations
The patient's laboratory parameters at the time of admission revealed...