Lumboperitonial shunt infection due to Chryseobacterium indologenes

A case of hospital-acquired pneumonia associated with Chryseobacterium indologenes infection in a patient with HIV infection and review of the literature

BACKGROUND

Chryseobacterium indologenes is an opportunistic, multidrug-resistant Gram-negative bacillus increasingly recognized as a cause of hospital-acquired infections, particularly in immunocompromised patients. Although rare, its intrinsic resistance to beta-lactams and its ability to colonize medical devices pose significant therapeutic challenges.

CASE PRESENTATION

We describe a case of C. indologenes hospital-acquired pneumonia in a 43-year-old HIV-positive patient with multiple comorbidities, including Kaposi sarcoma, diabetes mellitus, and chronic kidney disease requiring hemodialysis. The patient was initially admitted with fever and elevated inflammatory markers, and empirical broad-spectrum antibiotic therapy was initiated. Despite initial improvement, the patient developed respiratory failure, requiring oxygen therapy. A respiratory panel identified Rhinovirus, while sputum culture revealed C. indologenes, resistant to multiple antibiotics but susceptible to levofloxacin. Targeted therapy led to clinical improvement. However, the course was complicated by Clostridioides difficile-associated diarrhea, followed by fatal sepsis due to Klebsiella pneumoniae. Our review of the literature identified 71 reported cases, with bacteremia (51%) and pneumonia (29%) as the most common clinical presentations. Medical devices and prolonged antibiotic exposure were key risk factors. While C. indologenes is intrinsically resistant to beta-lactams and carbapenems, fluoroquinolones and trimethoprim-sulfamethoxazole demonstrated efficacy in most cases. Emerging therapies, such as cefiderocol, may provide additional options for multidrug-resistant strains. This case highlights the critical need for accurate microbial identification, targeted therapy, and vigilant antimicrobial stewardship to improve outcomes in vulnerable patient populations.

CONCLUSION

C. indologenes infections remain rare but clinically significant in hospitalized patients with immune dysfunction. The pathogen's multidrug resistance profile complicates treatment, necessitating early identification and targeted antimicrobial therapy. Fluoroquinolones, trimethoprim-sulfamethoxazole, and cefiderocol may serve as effective treatment options, emphasizing the importance of susceptibility-guided management.

Successful Treatment of Intracranial Infection Caused by Chryseobacterium Indologenes Following Aneurysm Clipping

Chryseobacteriumindologenes (C. indologenes) is a rare but emerging pathogen causing central nervous system (CNS) infections. It poses significant treatment challenges due to its antibiotic resistance. This case report describes the successful management of an intracranial infection caused by C. indologenes after aneurysm clipping, using a multidrug regimen. A retrospective analysis of the clinical course was performed, revealing that the patient responded well to intravenous Trimethoprim-Sulfamethoxazole (TMP/SMZ), oral Sulfamethoxazole (SMZ), and minocycline, resulting in complete resolution of the infection. The microbial characteristics of the infection and the subsequent treatment strategy were reviewed. Infections caused by C. indologenes present significant treatment challenges due to antibiotic resistance. A combination of intravenous TMP/SMZ, oral SMZ, and minocycline can be an effective therapeutic approach for managing such infections.

A Curious Case of Chryseobacterium indologenes Culture in a Young Adult Kidney Transplant Patient

Chryseobacterium indologenes (C. indologenes) is an increasingly common multidrug-resistant organism (MDRO) and is not part of the normal human flora. It is most commonly found in patients who are immunocompromised and/or in poor health, with multiple comorbidities. As an increasingly identified MDRO, C. indologenes needs to be identified early, especially in patients with multiple comorbidities, organ transplants, or on mechanical ventilation. We present a case of a young immunocompromised male with an extensive kidney disease history who acquired this new MDRO bacteria, C. indologenes.

Bacteremia by Chryseobacterium indologenes in a Patient with Lung Cancer: A Clinical and Microbiological Investigation

We present a case of bacteremia by an unsual, instrinsically multidrug resistant organism, Chryseobacterium indologenes in a 59 year old gentleman with squamous cell carcinoma of lung with multiple metastasis. Despite of treating as per sensitivity report after isolatingChryseobacterium indologenes, patient could not be survived. The pathogenicity and predictability of the organism towards antibiotics, bothin vivo and in vitro needs further research.

How to cite this article

Bhagawati G, Bhardwaj A et al. Bacteremia by Chryseobacterium Indologenes in a Patient with Lung Cancer: A Clinical and Microbiological Investigation. Indian J Crit Care Med 2019;23(3):157-159.

Chryseobacterium indolegenes infection in a patient with chronic obstructive pulmonary disease

Chryseobacterium indolegenes is a rare pathogen that causes a variety of infections in inviduals who are mostly hospitalized with severe underlying diseases. Here we present a case of C. indolegenes in a 69-year-old male with chronic obstructive pulonary disease (COPD) who was admitted to the chest disease outpatient clinic with symptoms like cough, fever and sputum production and followed up on a suspicion of pneumonia. Despite the fact that our patient did not have any history of hospitalization for at least one year, pneumonia cause was due to C. indolegenes. Clinicians should pay attention to the rare pathogens such as C. indologenes while managing COPD patients without prior hospitalization history.

In Vitro and In Vivo Control of Secondary Bacterial Infection Caused by Leishmania major

Bacterial infections of cutaneous leishmaniasis cause skin ulcers on mice, resulting in increased tissue deterioration, and these infections can be controlled with liquid allicin. To isolate and identify the incidences of real secondary bacterial infections in mice, we performed the current study by injecting mice (n = 50) with Leishmania major. L. major infections were initiated by an intramuscular injection of 0.1 mL Roswell Park Memorial Institute (RPMI 1640 media/mouse (107 promastigote/mL)). Scarring appeared 2-6 weeks after injection, and the bacteria were isolated from the skin ulcer tissues. Allicin (50 µL/mL) and ciprofloxacin (5 μg; Cip 5) were used for controlling L. major and bacteria. One hundred samples from skin ulcers of mice were examined, and 200 bacterial colonies were isolated. Forty-eight different genera and species were obtained and identified by Gram staining and physiological and biochemical characterization using identification kits. All samples were positive for secondary bacterial infections. Of the isolates, 79.16% were identified as Gram-negative bacteria, and 28.84% were identified as Gram-positive bacteria; only one yeast species was found. Interestingly, pure allicin liquid at a concentration 50 µL/mL exhibited antibacterial activity against a wide range of Gram-negative and some Gram-positive bacteria, in addition to yeast, and was 71.43% effective. Antimicrobial resistance patterns of all genera and species were determined using 15 different antibiotics. Allicin (50 µL/mL) and Cip 5 were the most effective against L. major and 92.30% of isolated bacteria. Stenotrophomonas maltophilia was the most resistant bacterium to the tested antibiotics with a survival rate of 73.33%, and it exhibited resistance to allicin.

Ventilator-associated pneumonia caused by Chryseobacterium indologenes: a rare infant case and review of the literature

Background

Chryseobacterium indologenes is an uncommon organism that has been documented to cause a variety of invasive infections mostly in hospitalized patients with severe underlying diseases.

Case presentation

A three-month-old female infant born at term by caesarean section with meningomyelocele and congenital diaphragmatic hernia had two surgeries for the repair of meningomyelocele and diaphragmatic hernia on her 3rd and 14th day, respectively. On the 3rd month of her life, she deteriorated clinically with fever, leukocytosis and increase of acute-phase reactants. Gas exchange condition became worse than it was before. Respiratory secretions, oxygen requirements and ventilator demand increased. Chest X-ray showed bilateral pulmonary infiltrates. Bacteriological blood, urine and cerebrospinal fluid culture test results were negative. C. indologenes was isolated from tracheobronchial secretion sample obtained by endotracheal aspiration. Although susceptible to ciprofloxacin (MIC:0.5 gr/L), levofloxacin and piperacillin–tazobactam, the isolate was resistant to meropenem, imipenem and colistin. She was treated with ciprofloxacin successfully. Her fever resolved and gas exchange condition improved after 72 h of the treatment. The antibiotic treatment was given for a course of 14 days.

Conclusion

Chryseobacterium indologenes may emerge as a potential pathogen in infants with the factors such as invasive equipment, having underlying diseases and prolonged hospitalization.

Six cases during 2012-2015 and literature review of Chryseobacterium indologenes infections in pediatric patients

Chryseobacterium indologenes is a widespread bacteria in the environment, especially hospitals, and a rarely reported human pathogen. The lowest frequency has been reported in children under 5 years of age. Clinical manifestations of C. indologenes include nosocomial pneumoniae, biliary tract infection, peritonitis, surgical wound infection, intravascular catheter-related bacteremia, cellulitis, and primary bacteremia. There is a knowledge gap in the management of C. indologenes infections, especially pertaining children, because of multiple antibiotic resistance and limited data in the literature concerning effective empirical treatment. In the published literature, a total of 16 cases of C. indologenes infections were reported in the pediatric age group. Herein, we present our experience in 6 children with C. indologenes infections. Early and prompt management of C. indologenes infections, particularly in children with mechanic ventilation, with polymicrobial infections, and under the age of 2 years, is of major importance because these factors seem to have a negative effect on the prognosis of infections caused by C. indologenes. Ciprofloxacin and TPM-SMX may be the best therapeutic choices for a combined initial empirical treatment of the patients.

Chryseobacterium indologenes: an emerging infection in the USA

Nursing home-associated infections and antibiotic resistant pathogens constitute common and serious problems in the geriatric population.Chryseobacterium indologenes, a non-motile Gram-negative rod, though widely distributed in nature, is an uncommon human pathogen. Typically thought of as an organism of low virulence, it may cause serious infections, particularly among the immunocompromised. The majority of reported cases are nosocomial, often associated with immunosuppression or indwelling catheters. It has been reported as the causative agent in bacteraemia, peritonitis, pneumonia, empyema, pyelonephritis, cystitis, meningitis and central venous catheter-associated infections. We report a rare case of C. indologenesinfection affecting a nursing home resident in the USA and we provide a review of similar cases. This report emphasises the importance of individualised treatment and promotes awareness about this organism as one of several emerging pathogens in immunocompromised adults and in the frail elderly who are often nursing home residents, in the Western Hemisphere.

Transient bacteraemia due to Chryseobacterium indologenes in an immunocompetent patient: a case report and literature review

A 51-year-old woman was admitted to the emergency unit with diffuse headache, visus reduction, and paraesthesias of the trigeminal area and the left hand. Three days after admission she showed shaking chills, vomiting, and sudden onset of fever (39·4°C). Blood cultures were performed soon after fever onset. Fever persisted for the whole day, decreasing slowly after 12 hours. No empirical antibiotic treatment was started in order to better define the diagnosis. Fever completely disappeared the day after. Two blood cultures for aerobes were positive for Chryseobacterium indologenes. The patient was discharged with the diagnosis of transient bacteraemia and transferred to the neurology unit for further investigations. C. indologenes infections are described in 31 studies with a total of 171 cases (pneumonia and bacteraemia being the most frequent). Our case is the first report of transient bacteraemia caused by C. indologenes in an immunocompetent, non-elderly patient without needing medical devices.

Chryseobacterium indologenes Septicemia in an Infant

Chryseobacterium indologenes is a rare cause of infection in children. The organism causes infections mostly in hospitalised patients with severe underlying diseases. The choice of an effective drug for the treatment of infections due to C. indologenes is difficult as the organism has a limited spectrum of antimicrobial sensitivity. We present a case of nosocomial septicemia caused by C. indologenes in an infant with congenital heart disease who was successfully treated with trimethoprim sulfamethoxazole and also reviewed fourteen additional cases of C. indologenes infections reported in the English literature in this report.

Neonatal meningitis and sepsis by Chryseobacterium indologenes: a rare and resistant bacterium

Early neonatal meningitis with non-fermenting Gram negative bacilli (NFGNB) is rare, and whenever it occurrs, inanimate environment is usually implicated as the source. The authors report a case of neonatal meningitis and sepsis with Chryseobacterium indologenes, a rare non fermenting Gram negative bacterium with unusual antimicrobial susceptibility. Despite resistance to all the beta lactams, carbapenems and aminoglycosides, therapy with ciprofloxacin led to a favorable outcome.

Treatment of Chryseobacterium indologenes ventilator-associated pneumonia in a critically ill trauma patient

OBJECTIVE

To report a case of Chryseobacterium indologenes ventilator-associated pneumonia (VAP) in a critically ill trauma patient.

CASE SUMMARY

This report describes a 66-year-old critically ill trauma patient who developed VAP, which was caused by C indologenes. The patient was injured in a riding lawn mower accident that trapped him underwater in a pond. The patient required surgery for intra-abdominal injuries and was mechanically ventilated in the trauma intensive care unit. On hospital day 5, the patient developed signs and symptoms of VAP. A diagnosis of C indologenes VAP was confirmed based on a quantitative culture from a bronchoscopic bronchoalveolar lavage. The patient's infection was successfully treated with moxifloxacin for 2 days followed by cefepime for 7 days.

DISCUSSION

Formally known as Flavobacterium indologenes, C indologenes is a Gram-negative bacillus normally found in plants, soil, foodstuffs, and fresh and marine water sources. Recently, worldwide reports of C indologenes infections in humans have been increasing, though reports from the United States are still rare. Bacteremia and pneumonia are the most commonly reported infections, and most patients are immunocompromised. The current case differs from most previous reports because this patient was in the United States and did not have any traditional immunocompromised states (eg, transplant, cancer, HIV/AIDS, or corticosteroid use).

CONCLUSION

This case report demonstrates that C indologenes can cause VAP in a trauma ICU patient.

Chryseobacterium indologenes in a woman with metastatic breast cancer in the United States of America: a case report

Introduction

We report the seventh case of Chryseobacterium indologenes occurring in the United States of America. C. indologenes is seldom isolated from clinical specimens but has caused hospital-acquired infections in Taiwan and rarely elsewhere.

Case presentation

A 32-year-old Caucasian woman with metastatic breast cancer presented to a hospital emergency department with bilateral radiation-induced pleural effusions and respiratory failure. The patient was hospitalized and ventilated for 26 days; tracheal aspirates collected on ventilation days 24 and 26 grew C. indologenes. The patient subsequently died as a result of worsening ventilator-associated pneumonia and stage IV breast cancer.

Conclusions

C. indologenes infection should be considered for hospitalized patients with a history of malignancy, especially those with indwelling devices and antibiotic use for >14 days.

Chryseobacterium indologenes central nervous system infection in infancy: an emergent pathogen?

The isolation of Chryseobacterium indologenes as a causative micro-organism in human diseases is rare. Risk factors for infections caused by this pathogen include very young and very old age, indwelling devices, immune suppression and recent use of broad-spectrum antibiotics. Most cases suffer from bacteraemia or nosocomial pneumonia, whilst infection of the central nervous system (CNS) is extremely rare. We present a term-born infant diagnosed prenatally with holoprosencephaly and obstructive hydrocephalus, requiring post-natal ventriculoperitoneal shunt insertion. At 6 weeks of age, he suffered from Escherichia coli meningitis, showing satisfactory clinical response with antimicrobial therapy. Aged 11 months, he suffered from hyper-drainage syndrome, resulting in the removal of the shunt system. He represented 11 days post-operatively, with low-grade fever, irritability and cerebrospinal fluid (CSF) leakage. C. indologenes from CSF was isolated and antimicrobial therapy with ceftazidime and trimethoprim-sulfamethoxazole for 3 weeks resulted in good clinical response. This is the first documented community-acquired CNS infection due to C. indologenes in an infant without concomitant indwelling device or previous antibiotic pressure.

Chryseobacterium indologenes subcutaneous port-related bacteremia in a liver transplant patient

Chryseobacterium indologenes is a rare cause of infection in select immunosuppressed hosts. Most prior reports are from Taiwan, in patients with diabetes mellitus or malignancies. Infections caused by C. indologenes are generally associated with indwelling devices, and the organism may be resistant to many commonly utilized broad-spectrum antibiotics. We report the first case, to our knowledge, of C. indologenes subcutaneous port-related bacteremia in a liver transplant recipient. The isolates were resistant to antibiotics previously reported as active, and device removal was required for treatment success.

Chryseobacterium indologenes infection in a newborn: a case report

Introduction

Chryseobacterium indologenes is an uncommon human pathogen. Most infections have been detected in hospitalized patients with severe underlying diseases who had indwelling devices implanted. Infection caused by C. indologenes in a newborn has not been previously reported.

Case presentation

We present a case of ventilator-associated pneumonia caused by C. indologenes in a full-term Caucasian newborn baby boy with congenital heart disease who was successfully treated with piperacillin-tazobactam.

Conclusion

C. indologenes should be considered as a potential pathogen in newborns in the presence of invasive equipment or treatment with long-term broad-spectrum antibiotics. Appropriate choice of effective antimicrobial agents for treatment is difficult because of the unpredictability and breadth of antimicrobial resistance of these organisms, which often involves resistance to many of the antibiotics chosen empirically for serious Gram-negative infections.

Chryseobacterium indologenes bacteremia in an infant

Chryseobacterium species are a rare cause of human disease and are usually associated with indwelling devices or altered immune status. This is the first case to our knowledge, of Chryseobacterium indologenes bacteremia in a previously healthy infant. Chryseobacteria are pathogens resistant to the usual empiric treatments for neonatal or infantile septicemia.