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The growing burden of multidrug-resistant infections among returned Australian travellers

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Clinical record

A previously well 66-year-old man was repatriated from Athens, Greece, to the Austin Hospital for ongoing management after a protracted hospital admission for an ischiorectal abscess secondary to perforated diverticulitis. This was complicated by faeculent peritonitis, multiple intra-abdominal abscesses and necrotising fasciitis of the abdominal wall. These complex problems required multiple laparotomies to drain and debride the abscesses, management of an open abdomen with vacuum-assisted closure dressings, and the formation of a loop sigmoidostomy. He also developed a grade IV sacral pressure ulcer with underlying sacral osteomyelitis. Organisms isolated from the intra-abdominal collections included carbapenem-resistant Pseudomonas aeruginosa and a carbapenemase-producing Klebsiella pneumoniae (blaKPC). Due to the complexity of the patient’s illness, he had spent 93 days in hospital in Greece, predominantly in intensive care, with three interhospital transfers within Greece before repatriation to Australia. Antibiotics administered in Greece included tigecycline, colistin, fosfomycin, vancomycin, clindamycin and anidulafungin.