CLINICAL CASE HISTORY:

A 55-year-old female presented to the emergency department after experiencing pain and redness of her right leg/foot The morning of her admission, the patient noticed bullous lesions on her right foot which became worse in a matter of hours The patient denied any trauma to the right foot but noted a fever and generalized malaise.

The past medical history included lower extremity cellulitis, cirrhosis of the liver, hepatitis C, acute renal failure, and morbid obesity. The patient presented to the Emergency Department with blood pressure of 114/69, heart rate of 81, and temperature of 101o.

The patient had significant lab results with an elevated white blood cell count, and erythrocyte sedimentation rate (ESR). The patient's right lower leg had extensive erythema extending from the knee to the base of the foot. The patient also had pain on palpation to the foot and leg.

She was also experiencing calf tenderness. Blood cultures were drawn on the patient, and an emergency incision and drainage of the foot and leg was performed.

The patient was started on vancomycin, clindamycin and maxipime. The patient returned to the OR six days postoperatively for further debridement. The set of two blood cultures became positive with this organism, Twenty-four hours after receipt by the microbiology laboratory

QUESTIONS:

1. Why was the patient susceptible to this organism?

2. How did this patient most likely acquire this infection? Explain.

3. Were the antibiotics initially given o the patient be suitable in the treatment of this organism? Explain.