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Myroides Soft Tissue Infections: Falling Outside of Practice Guidelines Apropos an Instructive Case

Alkiswany, Doaa, AA*; Bush, Larry, M., MD, FACP

Infectious Diseases in Clinical Practice: March 2018 - Volume 26 - Issue 2 - p 106–108
doi: 10.1097/IPC.0000000000000510
Case Reports

Previously classified as Flavobacterium odoratum, Myroides species, although not regular constituents of the normal endogenous human flora may occasionally cause clinical disease. Most infections follow either exposure to environmental sources or acquired nosocomially often linked to contaminated water. The bulk of nonhealthcare-associated infections involve skin and soft tissues resulting from a traumatic event frequently accompanied by bacteremia. Once considered to be “opportunistic pathogens,” infections with Myroides also occur in immunocompetent individuals. Their unanticipated involvement and inherent multidrug resistance often lead to treatment failures when empiric and practice guideline recommended antimicrobial regimens be administered. However, other than in specific circumstances, it remains in the best interest of “good practice,” antibiotic stewardship efforts, and patient care to adhere to evidence-based guidelines and avoid influences such as the case we present and anecdotal experiences suggesting that broad-spectrum empiric antibiotic prescribing is a prudent practice in the initial treatment of undefined skin and soft tissues.

This report depicts an uncommon soft tissue infection due to an unanticipated Gram-negative bacillus (Myroides), which exhibits inherent multi-drug resistance. This report reviews skin and soft tissue infection practice guidelines and encourages “good practice” and avoidance of prescribing patterns based upon uncommon anecdotal experiences.

From the *Nova Southeastern University, Palm Beach County, FL; and †Clinical Biomedical Sciences, Charles E. Schmidt College of Medicine, Florida Atlantic University, University of Miami-Miller School of Medicine, Palm Beach County, FL.

Correspondence to: Larry M. Bush, MD, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL 33414. E-mail:

The authors have no funding or conflicts of interest to disclose.

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