Background:

Aeromonas spp. are gram-negative anaerobic rods that are mainly found in water. Respiratory infections due to Aeromonas sp. are rare but have a high mortality rate.
Case presentation:
A 43-year-old man fell into a river following an automobile accident and almost drowned. He developed a severe respiratory infection and acute respiratory distress syndrome. Ampicillin/sulbactam was given; however, Aeromonas caviae was detected in his blood culture. Despite treatment with levofloxacin, to which A. caviae was susceptible, his condition failed to improve. However, with additional treatment with cefepime, his blood culture results were negative, and his condition improved.
Conclusion:
When a patient develops a respiratory infection after aspiration of river water, empiric antimicrobial therapy should be given as soon as possible to manage the risk of Aeromonas sp. infection.