[22110132]
Pt had a traumatic finger amputation on (b)(6) 2012 and surgical reimplantation was attempted along with use of leech therapy from (b)(6) 2012. Ertapenem given as prophylaxis during this time. The reimplantation was not successful and the digits were subsequently removed via surgical amputation. Soft tissue coverage was provided with a radial forearm flap and split thickness skin grafting. On (b)(6) 2012,the skin graft appeared infected. Cultures of the tissue were done on (b)(6) 2012 and grew aeromonas resistant to ertapenem and fluoroquinolones. The pt required 3 surgical irrigation/debridement procedure, hyperbaric oxygen therapy and 19 days of iv antibiotics including home infusion therapy. The infectious disease attending and i would be happy to have a phone discussion about this if desired. I have attempted to discuss with (b)(6) to see if they had other reports of this but they gave incorrect info, and clearly had no medical or antibiotic knowledge. We plan to discuss with (b)(4) early next week - they are the suppliers and i believe are the ones with the fda approval. As an aside, there was incorrect info in the (b)(6) package insert, which is part of the reason they were giving misinformation. It said the quinolones and tmp/smx were 3rd generation cephalosporins. The lady on the phone kept saying we caused the infection because we did not give a 3rd gen cephalosporin. Our micro lab has retained the specimen from the (b)(6) as well.
Patient Sequence No: 1, Text Type: D, B5