Bullous cellulitis with bacteraemia caused by multi-drug resistant Myroides odoratimimus species

Myroides odoratimimus is an aerobic, non-fermenting notoriously multi-drug resistant bacillus which is ubiquitous in the environment, rarely implicated in human disease. We report a case of a man in his 60 s with multiple comorbidities who presented with a two day history of acute swelling, erythema and tenderness of the left leg and foot, associated with oozing, ulceration and bullous lesions. The blisters were serous filled and ruptured upon contact (see Figure 1). Blood cultures and wound cultures yielded the multi-drug resistant organism Myroides odoratimimus. Treatment is challenging due to extensive intrinsic antimicrobial resistance. Susceptibility testing confirmed sensitivity to meropenem and co-trimoxazole (see Table 1), the patient was treated with combination therapy resulting in rapid reduction of inflammatory markers and resolution of lesions (see Figure 2). This case outlines how cirrhosis / poorly controlled diabetes impacts the infection risk of the host and how infection with Myroides species may occur without a clear environmental exposure as well as the implications this organism may have on infection control measures.