Serratia fonticola and its role as a single pathogen causing emphysematous pyelonephritis in a non-diabetic patient: A case report

Abstract

BACKGROUND Diagnosis of emphysematous pyelonephritis has been described around the world for some decades, frequently associated with Escherichia coli and other anaerobic, gas-forming bacteria and mostly in patients living with diabetes. We present a case report of emphysematous pyelonephritis in a non-diabetic patient caused by Serratia fonticola as well as a brief literature review to draw attention to this rare pathogen as a cause of pyelonephritis. CASE SUMMARY A 38-year-old female presented with fever, severe pain in the right flank and changes in urinary habits. She was admitted, and emphysematous pyelonephritis was confirmed by an abdominal computerized tomography and urine cultures; the latter showed Serratia fonticola as a single pathogen. After 3 d of being treated with piperacillin/tazobactam and percutaneous drainage she became afebrile, and the gas presence reduced. CONCLUSION Emphysematous pyelonephritis infections in non-diabetic patients are rare but can be severe and life-threatening. This case suggests that Serratia fonticola infection can occur in patients undergoing invasive or instrumented procedures.

Unveiling the Menace of Serratia fonticola: Rising Pathogenic Threat or Bystander?

“…However, only one case (case 2) survived, while cases 3 and 4 resulted in fatalities. Other studies by Villasuso-Alcocer et al and Mahajan et al have shown successful outcomes using treatments other than ceftriaxone despite invasive interventions such as surgical removal of a cerebellar abscess and combined endoscopic intrarenal surgery, respectively [ 6 , 11 ].…”

“…This is linked to the presence of a FOMA-type and an inducible chromosomal β-lactamase AmpC in Serratia. These not only confer antibiotic resistance but also facilitate the transmission of antimicrobial resistance elements to other bacteria, increasing the risk of rapid development into polymicrobial bacteremia or septicemia [6]. Earlier, Gorret et al reported a patient treated empirically with gentamicin and cloxacillin, later shifting to ciprofloxacin and ceftriaxone after surgery [10].…”

“…A few reported cases of S. fonticola associated with human infection were reported in the medical literature. These cases include various infections such as urinary tract infections [3,5], emphysematous pyelonephritis [6], endocarditis [7], skin infections in the diabetic foot [8], biliary tract infection [9], infection complicating parotid malignant tumors [10], cerebellar abscess [11], knee septic arthritis [12], bloodstream infections [4,12], and even an infection following a bear bite [13]. The instances described here demonstrate how S. fonticola, which is often thought of as an opportunistic disease, can produce serious and delayed infections that demand several aggressive surgeries and broad-spectrum antibiotic treatment.…”