Abstract We describe a case of necrotizing fasciitis in the United Kingdom in which Pseudomonas guariconensis was isolated from multiple blood culture and tissue samples. The organism carried a Verona integron-encoded metallo-β-lactamase gene and evidence of decreased susceptibility to β-lactam antimicrobial agents. Clinicians should use caution when treating infection caused by this rare pathogen. A 67-year-old man in the United Kingdom was seen in the emergency department for right lower leg pain and swelling with associated fevers lasting 24 hours. He reported a right heel blister had formed 1 week earlier, after he purchased new footwear. His medical history included obesity, hypertension, atrial fibrillation, and left ventricular systolic dysfunction. He was a former smoker and had a 40 pack-year history. On examination, the patient appeared alert and comfortable. He was febrile (38.0°C), tachycardic (124 beats/min) in atrial fibrillation, and had a stable blood pressure (108/72 mm Hg). His respiratory rate was 20 breaths/min, and oxygen saturation was 92% on room air. He had right leg swelling and erythema, extending from the blister on his heel to his mid-calf. Blood test results showed leukocyte count was 15.03 × 10 9 cells/L (reference range 4.0–11.0 cells/L), neutrophils 13.44 × 10 9 cells/L (reference 1.5–8.0), and lymphocytes 0.38 × 10 9 cells/L (reference 1.0–4.0). Bilirubin was 41 µmol/L (reference <21), albumin 34 g/L (reference 35–50), and C-reactive protein 20 mg/L (reference <6.0). The patient was started on intravenous flucloxacillin (1g 4×/d) for lower limb cellulitis. Aerobic blood culture samples at admission were positive at 11.5 hours’ incubation and cultures collected 8 hours after admission positive at 10.5 hours’ incubation by BD Bactec FX system (Becton Dickinson, https://www.bd.comExternal Link ). Gram stain from the samples showed gram-negative bacilli, resulting in an immediate change of therapy to intravenous amoxicillin/clavulanic acid (1.2 g 3×/d) and [...]
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