Necrotizing fasciitis caused by Myroides spp., an emerging multidrug-resistant microorganism. Case report

Abstract

Introduction: The genus Myroides is comprised of non-motile, aerobic, often opportunistic Gram-negative bacilli. There are two clinically relevant species, M. odoratus and M. odoratimimus. It is frequently associated with skin and soft tissue infections in immunocompromised patients. The genus Myroides is frequently multiresistant to antibiotics. Case report: A 15-year-old male with chronic malnutrition presented with a crush trauma to the left foot with a multifragmentary fracture. The patient had a torpid evolution with necrosis of the toes of the left foot. Initial studies showed no leukocytosis with elevated CRP. He underwent three surgical cleanings. After the first surgical cleaning, a wound secretion culture reported growth of Myroides spp. sensitive to ciprofloxacin, imipenem, levofloxacin, and piperacillin/tazobactam. He completed ten days of antibiotic therapy based on ciprofloxacin and clindamycin. Diagnosis: A culture of medium-sized non-fermenting gram-negative bacilli colonies was obtained from the secretion sample. Intervention and results: Ten days of antibiotic therapy with ciprofloxacin and clindamycin were completed after the identification of Myroides spp. with adequate clinical evolution. Total amputation of the left foot was avoided. In subsequent controls, the patient walked independently with stability. Conclusions: The described case denotes the pathogenicity of Myroides and highlights the importance of risk factors, such as chronic malnutrition and open wounds. The recognition of Myroides as an emerging pathogen is important given its resistance to multiple antibiotics and the complexity of its treatment, which can have a clinical presentation ranging from cellulitis to rapidly fatal necrotizing fasciitis and septic shock.