Edwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Factors.

BACKGROUND Edwardsiella tarda is a facultative anaerobic bacterium that is rarely pathogenic to humans, but, in patients with certain risk factors, it can lead to severe, disseminated infections. Humans are inoculated through the gastrointestinal tract while consuming undercooked or raw seafood or through skin penetration. E. tarda has been isolated from marine environments, including lakes, rivers, wells, and sewage water. Although the bacterium has not been directly isolated from seawater, it has been cultured from animals inhabiting seawater environments. In the United States, E. tarda is predominantly localized along the coastline of the Gulf of Mexico. Complications from this bacterium usually arise in patients with liver disease, iron overload, or cirrhosis or in those who are immunocompromised or on immunosuppressive therapy. CASE REPORT Our patient was a 59-year-old woman with a history of advanced lung cancer, pulmonary hypertension, liver cirrhosis, hepatitis C, and alcoholism. She initially presented to the Emergency Department in the Florida Panhandle on June 16 with colitis, which then progressed to fulminant sepsis with septic shock. Despite aggressive interventions, including intravenous hydration, broad-spectrum antibiotics, and vasopressor support, our patient succumbed to her illness approximately 34 h after initial presentation. CONCLUSIONS Although severe cases of E. tarda have been reported in patients with liver dysfunction, we believe this is the first reported case potentially complicated by concomitant lung cancer. The rise in sea water temperature, increased human consumption of raw seafood, and increased prevalence of nonalcoholic steatohepatitis may increase the incidence and mortality of E. tarda in the near future.

Compatibility and stability of cefotaxime, vancomycin, and ciprofloxacin in antibiotic lock solutions containing heparin.

The purpose of this study was to assess the compatibility and stability of drugs commonly found in antibiotic lock solutions (cefotaxime 10 mg/mL plus heparin 5000 IU/mL, vancomycin 25 mcg/mL plus heparin 10 IU/mL, and vancomycin 25 mcg/mL plus ciprofloxacin 2 mg/mL plus heparin 10 IU/mL). Antibiotic lock solutions under investigation were generated in triplicate from pooled starting samples and maintained at 4 degrees Celsius, 27 degrees Celsius, and 40 degrees Celsius. The antibiotic lock solutions were assessed at various time intervals for chemical stability (specified as retaining greater than 90% of initial drug via high-performance liquid chromatographic analysis) and physical stability(specified as solution free of visible precipitates). Antibiotic lock solutions containing cefotaxime plus heparin remained chemically and physically stable at 4 degrees Celsius throughout the study period. However, samples maintained at higher temperatures had no physical instability but underwent significant chemical degradation as early as 24 hours after the beginning of the incubation period. Vancomycin in antibiotic lock solutions with heparin also remained chemically and physically stable at 4 degrees Celsius but underwent minor chemical degradation (with no physical instability) at higher temperatures. Vancomycin and ciprofloxacin in antibiotic lock solutions with heparin demonstrated physical instability at all temperatures by 24 hours. In conclusion, none of the antibiotic lock solutions tested met the chemical and physical stability criteria specified at the beginning of the study. These results suggest that the efficacy of these antibiotic lock solutions is decreased due to chemical or physical instabilities over time.