Critical Review

Letters to the Editor Emphysematous Cystitis by Dr. med. Christopher Kloth, Prof. Dr. med. Jens Bedke, and Dr. med. Heike Preibsch in issue 27–28/2020

The authors reported the case of a patient with the signs of acute abdomen and septic shock (1). The patient was obviously empirically treated with tazobactam and metronidazole. This combination is an unfortunately widespread over-treatment because piperacillin/tazobactam covers the spectrum of metronidazole—that is, it is effective against anaerobic pathogens. We are not aware of a pathogen by the name of “Enterococcus cloacae.” Enterococcus spp are gram positive cocci that may have a role in urinary tract infections. In the reported case it is more likely that Enterobacter cloacae, a gram negative bacillus, was confirmed. Confirmation of the pathogen was probably accompanied by a relevant antibiogram, which should have led to targeted therapy. We cannot understand the selected combination of two potent beta-lactam antibiotics with a similar effectiveness spectrum, which should be regarded as over-treatment. The additional use of the antimycotic drug fluconazole is not justified in the absence of a fungal infection, even in a patient with diabetes. Thankfully, the patient’s “infectious parameters” improved.

DOI: 110.3238/arztebl.m2021.0061

Prof. Dr. med. Arne C. Rodloff

Prof. Dr. med. Christoph Lübbert, DTM&H

Interdisziplinäres Zentrum für Infektionsmedizin des
Universitätsklinikums Leipzig

References

1. Kloth C, Bedke J, Preibsch H: Emphysematous cystitis. Dtsch Arztebl Int 2020; 117: 487