Expanding spectrum of opportunistic Cedecea infections: Current clinical status and multidrug resistance

Abstract

Members of the bacterial genus Cedecea cause acute infections worldwide in compromised hosts with serious underlying medical conditions. While global reports of Cedecea infections remain sporadic in the medical literature, cases of multidrug-resistant clinical isolates have been documented each year over the past decade, warranting a comprehensive update on this emerging opportunistic pathogen. Here, we review the clinical manifestations, pathogenesis, natural distribution, epidemiology, and antimicrobial resistance of Cedecea species. Acute infection commonly manifests as bacteremia and pneumonia; however, the spectrum of infectious pathologies associated with Cedecea has expanded to include oral and cutaneous ulcers, orbital cellulitis, and peritonitis. The frequency of resistance among reported clinical isolates was highest to ampicillin, cephalothin, cefoxitin, cefazolin, and ceftazidime. Cedecea isolates harboring metallo-β-lactamases exhibited resistance to carbapenems and fourth-generation cephalosporins. Further research is needed to understand the pathogenicity and multidrug resistance of Cedecea species. Appropriate therapeutic management of Cedecea infections depends on antibiotic susceptibility testing because of variable resistance patterns and the enhanced infection risk in vulnerable populations.

Genomic Insights into Drug Resistance Determinants in Cedecea neteri, A Rare Opportunistic Pathogen

“…Six open-reading frames (ORFs) in the C. neteri SSMD04 genome (Cnt) are annotated as unclassified β-lactamases based on a previous KEGG database search [ 36 ], compared with 9 ORFs in strain M006 and 11 ORFs in strain ND14a. As environmental Cedecea species exhibit a natural phenotype of resistance to certain clinically important β-lactam antibiotics [ 3 ], we further analyzed these six putative β-lactamase-encoding ORFs in more detail. The deduced primary sequences of four of these genes have the metallo-beta-lactamase (MBL) protein fold (αβ/αβ) distinctive of the metallo-hydrolase/oxidoreductase superfamily based on the presence of Pfam domains ( Table 2 ).…”

“…The genus Cedecea comprises Gram-negative, facultatively anaerobic bacilli that are non-sporulating and fermentative [ 1 ]. Like other genera in the Enterobacteriaceae family, Cedecea species are widely distributed in aquatic and soil environments, as well as associated with plants, insects, the human gut microbiome, and non-human animals (reviewed in [ 2 , 3 ]). Three validly recognized species ( Cedecea davisae , Cedecea lapagei , and Cedecea neteri ) have documented clinical relevance in humans and collectively, have been reported to cause such diverse acute infections as pneumonia [ 4 , 5 , 6 , 7 , 8 , 9 ], bacteremia [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], cutaneous and oral ulcers [ 13 , 14 , 20 , 21 ], and dialysis-related peritonitis [ 22 ].…”

“…While Cedecea infections have been reported sporadically in the literature, clinical cases of this emerging opportunistic human pathogen continue to occur worldwide. Clinical strains of Cedecea species exhibit natural resistance to various antimicrobial agents, including ampicillin, ampicillin-sulbactam, cefazolin, cephalothin, cefoxitin, and colistin [ 3 ]. The multidrug-resistant phenotype of one C. lapagei isolate was attributed, in part, to the acquisition of the bla NDM-1 gene, which encodes the New Delhi metallo-β-lactamase-1 (NDM-1) [ 18 ].…”

Urinary tract infection by a rare pathogen Cedecea neteri in a pregnant female with Polyhydramnios: rare case report from UAE

“…The latest literature review indicates the highest frequency of Cedecea spp. resistance to ampicillin (43%), followed by cephalothin (35%), cefoxitin (35%), cefazolin (22%), ceftazidime from a total of 23 isolates reported to date [ 11 ]. Carbapenems and 4th generation cephalosporin resistance may be exhibited in Cedecea isolates harboring metallo- β -lactamase.…”

The Isolation of Culturable Bacteria in Ixodes ricinus Ticks of a Belgian Peri-Urban Forest Uncovers Opportunistic Bacteria Potentially Important for Public Health

“…One of the Proteobacteria isolated from site 2, Cedecea davisae was particularly noteworthy because a common clinical presentation of infection is bacteremia and it is inherently resistant to antibiotics [42,43]. It is a rare opportunistic bacterium, one of the five species in the genus Cedecea, with C. neteri and C. lapagei [44].…”