Escherichia fergusonii Bacteremia in a Diabetic Patient with Pancreatic Cancer

Abstract

Although Escherichia fergusonii has been identified for decades, it has rarely been recovered from clinical specimens and its clinical significance remains unclear. We describe a case of E. fergusonii bacteremia in a diabetic patient with pancreatic cancer. The isolate was confirmed by three commercial identification systems and 16S rRNA gene sequence analysis. The patient's clinical condition gradually improved, and repeated blood cultures were negative after antibiotic treatment with an in vitro active agent (ceftriaxone). CASE REPORTA 73-year-old man who had a history of diabetes mellitus and pancreatic cancer presented with fever, vomiting, and abdominal discomfort for 1 day. On arrival at the emergency department, his body temperature was 38.6°C, and blood pressure was 98/51 mm Hg. Physical examination was unremarkable except for abdominal tenderness without rebounding pain. The laboratory findings were as follows: white blood cell count, 6,920/l with predominance of neutrophils (93%); Creactive protein level, 10.7 mg/dl (normal reference, Ͻ0.8 mg/ dl); lactic acid level, Ͼ12 mmol/liter (normal reference, 0.5 to 2.2 mmol/liter). Chest radiography did not show pneumonia patch, and urinalysis did not reveal pyuria. Computed tomography (CT) of the abdomen showed narrowing of celiac artery, superior mesenteric artery, and inferior mesenteric artery; dilatation of bowel; and edema of bowel wall. Under the impression of ischemic bowel diseases with severe sepsis, intravenous piperacillin-tazobactam (4.5 g every 8 h) was administered after collection of two sets of blood cultures. Four days later, two sets of blood cultures both grew Klebsiella pneumoniae and Escherichia fergusonii. These two isolates were susceptible to amoxicillin-clavulanic acid, piperacillin-tazobactam, cefuroxime, ceftriaxone, cefepime, imipenem, ciprofloxacin, gentamicin, and amikacin but resistant to ampicillin by the disk diffusion method. Antibiotic was shifted to ceftriaxone (1 g every 12 h) thereafter, the patient's fever gradually subsided, and repeat blood cultures 7 days after ceftriaxone use were negative. However, another episode of nosocomial infection with candidemia occurred on the 30th day after admission, and acute respiratory failure and shock developed then. Despite intravenous fluconazole being added for fungemia, the patient finally died on the 37th day after admission.The E. fergusonii isolate was identified by using three commercial identification systems: Enterotube II (Becton Dickinson Diagnostic Systems, Sparks, MD) (biocode 36640), PMIC/ ID-30 (Becton Dickinson Diagnostic Systems) (confidence value, 97%; sequence number 420070812594), and Vitek 2 system GN card (bioMérieux Inc., La Balme les Grottes, France) (probability of identity, 94%; bionumber 6605610160546211). The organism was positive for fermentation of amygdalin and cellobiose but negative for melibiose and sorbitol. This organism was further confirmed to the species level by partial 16S rRNA gene sequence analysis as previously described (7). The amplifica...

Microbiome analysis reveals the abundance of bacterial pathogens in Rousettus leschenaultii guano

“…It has also been recovered from the wound infections, UTIs, diarrhea etc 48. and reported to cause the bacteremia in diabetic patient49. The other dominating genera cultivated was Enterobacter e.g.…”

First Detection of Carbapenem-Resistant Escherichia fergusonii Strains Harbouring Beta-Lactamase Genes from Clinical Samples

“…Escherichia fergusonii closely related to the ExPECs with about 60% similarity, was classified in 1985 as a new specie [7]. Escherichia fergusonii are opportunistic pathogens primarily associated with abdominal wounds, UTIs and bacteraemia in humans while causing septicaemia and diarrhoea in animals [7,[12][13][14][15][16][17][18]. Not much is currently known about E. fergusonii.…”

Splenic Abscess Requiring Early Splenectomy following Angioembolization for Blunt Splenic Injury in an Immunocompromised Host: Implications for Management

“…The specific organism isolated from the blood and the spleen of the patient, E. fergusoniii, described in this report differs from the organisms typically cultured from splenic abscesses in immunocompetent patients, namely, Clostridium perfringens, alpha-hemolyticus Streptococcus, gram-positive Staphylococcus, gramnegative Salmonella, Candida, and Aspergillus. 4 Escherichia fergusonii is an enteric organism isolated more commonly in immunocompromised patients.…”