A Case of Pseudomonas mendocina Bacteremia in an Elderly Man With Bilateral Leg Lesions.

Pseudomonas mendocina is a gram-negative, aerobic, rod-shaped bacterium that rarely causes disease in humans. Documented infections can be severe with varying etiologies, often requiring intensive care. We describe a rare case of bacteremia with P. mendocina in an elderly male, with a comprehensive review of the literature. An 81-year-old Caucasian male presented with bilateral lower leg erythema and drainage but was afebrile. His past medical history included atrial fibrillation, chronic kidney disease, and congestive heart failure. Labs showed leukocytosis and a blood culture was obtained revealing Pseudomonas mendocina. The pathogen was susceptible to all antibiotics tested and he was successfully treated on cefepime inpatient and a two-week course of ciprofloxacin on discharge. Our case and literature review presents a successful treatment of a rare cause of bacteremia likely stemming from a soft tissue nidus. P. mendocina has a favorable susceptibility profile and the antibiotics preferred differ from Pseudomonas aeruginosa, a more common pathogen. Worldwide there have been only 18 other documented cases of P. mendocina infection, all successful and with no mortality. Physicians can confidently utilize usual antibiotics in the treatment of this pathogen despite its rare clinical manifestations.

Risk Factors in Hospitalized Patients for Heparin-Induced Thrombocytopenia by Real World Database: A New Role for Primary Hypercoagulable States.

Background: The aims of the study were to identify predictors of heparin-induced thrombocytopenia (HIT) in hospitalized adults, and to find additional factors associated with higher odds of HIT in primary hypercoagulable states. Methods: A retrospective matched case-control study using discharge data from National Inpatient Sample database (2012 - 2014) was conducted. In primary outcome analysis, hospitalized patients with and without HIT were included as cases and controls, both matched for age and gender. In secondary outcome analysis, hospitalized patients with primary hypercoagulable states with and without HIT were included as cases and controls, both matched for age and gender. The statistical analyses were performed using Statistical Package for Social Sciences version 25. Results: There are several predictors of HIT in hospitalized patients, such as obesity, malignancy, diabetes, renal failure, major surgery, congestive heart failure, and autoimmune diseases. In patients with primary hypercoagulable states, the presence of renal failure (odds ratio (OR) 2.955, 95% confidence interval (CI) 1.994 - 4.380), major surgery (OR 1.735, 95% CI 1.275 - 2.361), congestive heart failure (OR 4.497, 95% CI 2.466 - 8.202), or autoimmune diseases (OR 1.712, 95% CI 1.120 - 2.618) further increases the odds of HIT. Conclusions: In hospitalized patients with primary hypercoagulable states, especially in association with renal failure, major surgery, congestive heart failure, or autoimmune diseases, unfractionated heparin should be used with caution.