INTRODUCTION
Empedobacter brevis (E. brevis) is a gram-negative, nonmotile, aerobic bacteria that is part of the Flavobacteriaceae family.1 It is mostly found in water sources, plants, soils, and more recently, hospital environments.1 There have been emerging cases of human infections, although still rare. Among the human infection cases reported in the literature, a few are skin infections that seem to be from environmental sources. We present yet another Empedobacter brevis skin infection in a 61-year-old male who presented with a persistent skin infection.
CASE
This is a 61-year-old male with a past medical history of hyperlipidemia, hypertension, actinic keratoses, history of valve replacement (on chronic warfarin therapy), and history of knee replacement a year prior. He presented with a dark, erythematous plaque with central hemorrhagic crusting on his right mid-thigh (Figure 1).
The patient reported that he had been doing yard work six weeks prior when he noticed a “red bump” about the size of a “match head” on his thigh. He attributed it to a possible insect bite, but the lesion persisted after a few weeks, so he cleaned it with hydrogen peroxide and antibiotic bandages. He reported no pain, but his wound was mildly pruritic.
The lesion was initially attributed to a S. aureus infection given the presentation, so he was placed on mupirocin ointment. His wound culture results returned as gram negative bacilli and was identified by DNA sequencing as Empedobacter Brevis (E. brevis).
Sensitivities showed that the bacteria was resistant to meropenem and tobramycin. He was started on Sarecycline and his wound improved (Figures 2 and 3).
The patient reported that he had been doing yard work six weeks prior when he noticed a “red bump” about the size of a “match head” on his thigh. He attributed it to a possible insect bite, but the lesion persisted after a few weeks, so he cleaned it with hydrogen peroxide and antibiotic bandages. He reported no pain, but his wound was mildly pruritic.
The lesion was initially attributed to a S. aureus infection given the presentation, so he was placed on mupirocin ointment. His wound culture results returned as gram negative bacilli and was identified by DNA sequencing as Empedobacter Brevis (E. brevis).
Sensitivities showed that the bacteria was resistant to meropenem and tobramycin. He was started on Sarecycline and his wound improved (Figures 2 and 3).
DISCUSSION
Thought to be an environmental pathogen, increasing cases of human E. brevis infections are now being reported as portrayed in Table 1. Cases have been ranging from neonates to the elderly, namely those who are immunocompromised.2-5 Exposure of E. brevis can be from hospital facilities to soils, water sources, and plants--as also depicted in some of the reported cases. Treatment of infection due to E. brevis is by antibiotics that have activity against gram-negatives, although it can be complicated by resistance to certain beta-lactams due to E. brevis’ betalactamase gene (EBR-1), conferring resistance to extended cephalosporins and carbapenems, as demonstrated by the sensitivities from our patient.6
While human E. brevis infections increase, its dermatologic
While human E. brevis infections increase, its dermatologic
