Jpn. J. Infect. Dis., 58, 34-35, 2005
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Short Communication
Biliary Infection and Bacteremia Caused by b-Lactamase-Positive, Ampicillin-Resistant Haemophilus influenzae in a Diabetic Patient
Sukru Oksuz*, Elif Ozturk, Idris Sahin, Osman Ertor1 and Demet Kaya
Department of Microbiology and Clinical Microbiology and 1Department of Clinical Microbiology and Infectious Disease, Faculty of Medicine, Abant Izzet Baysal University, Duzce 81100, Turkey
(Received April 15, 2004. Accepted September 22, 2004)
*Corresponding author: Mailing address: Department of Microbiology and Clinical Microbiology, Abant Izzet Baysal University Duzce Medical School, 81100 Duzce, Turkiye. Tel: +90-380-5414107-2014, Fax: +90-380-5414105, E-mail: sukruoksuz@hotmail.com, sukruoksuz81@mynet.com
SUMMARY: We report the case of a 73-year-old female patient with diabetic nephropathy and cholelithiasis. She was admitted to our hospital with right upper abdominal pain, nausea, and vomiting. The patient had visited an outpatient clinic with the same complaints 2 days earlier, and had been prescribed antibiotics empirically (two doses ofloxacin orally). Blood cultures taken before the start of antibiotic treatment in our hospital were negative. The patient was treated with parenteral ampicillin/sulbactam + ciprofloxacin empirically. The empiric antibiotic treatment was discontinued after 7 days. Elective cholecystectomy was performed after her general condition improved. An aerobic chocolate agar culture of the cholecystectomy material yielded Haemophilus influenzae type b. On postoperative day 3 the patient developed fever again. The fluids collected after cholecystectomy were evaluated microbiologically. H. influenzae type b was isolated from the samples and blood cultures. The patient was diagnosed with H. influenzae cholecystitis, and recovered after10-day treatment with ampicillin/sulbactam + ciprofloxacin. The findings are discussed together with references for differential diagnosis. H. influenzae cholecystitis due to cholelithiasis, although rare, should be considered in elderly patients with a history of chronic diseases such as diabetes mellitus or nephropathy.