SHM Converge Scientific Abstract ePoster Gallery-Infection Caused by Buttiauxella Izardii/Agrestis Following Open Forearm Fracture: A Rare Environmental Pathogen in Post-Traumatic Fixation

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This case report describes a rare postoperative infection caused by <strong>Buttiauxella izardii/agrestis</strong>, an unusual environmental gram-negative rod in the Enterobacteriaceae family found in <strong>soil and water</strong>. Human infections are very uncommon, and hardware-associated infections have rarely been reported.

A <strong>39-year-old woman</strong> developed this infection after an <strong>ATV accident in Lebanon</strong> caused an <strong>open midshaft radius and ulna fracture</strong> and a <strong>proximal humerus fracture</strong>. She underwent urgent <strong>open reduction and internal fixation with irrigation and debridement</strong> abroad. About <strong>10 days later</strong>, she developed <strong>persistent purulent drainage</strong> from the surgical site. Initial treatment with <strong>amoxicillin-clavulanate</strong> and then <strong>trimethoprim-sulfamethoxazole</strong> did not improve her symptoms.

After returning to the United States, she continued to have <strong>drainage and pain over the fixation plate</strong>, prompting <strong>repeat surgical irrigation and debridement with sinus tract excision</strong>. Operative cultures identified <strong>Buttiauxella izardii/agrestis</strong>. She was treated with <strong>ciprofloxacin</strong>, followed by <strong>suppressive minocycline</strong> because the hardware was retained, and the infection resolved.

The report highlights several important points:  
- Buttiauxella species are rare but can cause human infection.  
- The organism may produce an <strong>inducible AmpC-type β-lactamase</strong>, which can reduce susceptibility to some beta-lactam antibiotics.  
- <strong>Open fractures</strong>, especially those exposed to contaminated environments or treated internationally, can involve atypical pathogens.  
- <strong>Early culture collection</strong> and <strong>multidisciplinary management</strong> are critical for successful treatment.

Overall, this case emphasizes the need to consider rare environmental organisms in persistent orthopedic infections after trauma and hardware placement.

Asset Subtitle

Vishal Patel

Meta Tag

Author List Ethan Snyder, Patrick DeSpain, Pranayvir S. Lotey, Vishal Patel

Category Clinical Vignettes

Concept Buttiauxella species

Concept Orthopedic hardware infection

Concept Microbiology-directed antimicrobial therapy

Concept Open Fracture

Concept Debridement

Distinguished Non-Finalist

Presenter Organization UT Health Houston

Presenting Author Vishal Patel

Track Adult

Keywords

Buttiauxella izardii/agrestis

postoperative infection

orthopedic hardware infection

open fracture

environmental gram-negative rod

Enterobacteriaceae

soil and water

inducible AmpC beta-lactamase

sinus tract excision

ciprofloxacin minocycline

Buttiauxella species

Orthopedic hardware infection

Microbiology-directed antimicrobial therapy

Open Fracture

Debridement