Necrotizing pneumonia caused by mixed infection with Actinobacillus actinomycetemcomitans and Actinomyces israelii: case report and review.

Actinobacillus actinomycetemcomitans is an important cause of human pulmonary infections, either alone or with Actinomyces species. It may be critical to isolate Actinobacillus in patients with pulmonary infection for selection of an effective antimicrobial regimen. Clindamycin has superseded penicillin as the sole antimicrobial drug for anaerobic bacterial necrotizing pneumonia and abscess. In the case presented herein, therapy with clindamycin failed to halt worsening necrotizing pneumonia or to prevent hematogenous dissemination. After clindamycin-resistant A. actinomycetemcomitans in addition to Actinomyces israelii were isolated, the patient was treated with penicillin, ciprofloxacin, and cefazolin and was ultimately cured.