Chryseobacterium indologenes Sepsis Due to an Infected Central Catheter in a Patient With Metastatic Breast Cancer to the Skin

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.

Chryseobacterium indologenes Keratitis: Successful Treatment of Multidrug-Resistant Strain

A 72-year-old male with history of monocular vision with complete vision loss in his right eye from previous retinal detachment presented with 20/200 vision in the left eye with a corneal ulcer. Culture was obtained, and the patient was started on fortified tobramycin, fortified vancomycin, and amphotericin. Despite the antibiotics, the patient did not significantly improve, after which another culture was obtained before the patient was taken to the surgery for cryotherapy and a partial conjunctival flap. The culture identified Chryseobacterium indologenes. There have been fewer than a handful of cases reported in the last three decades with different antibiotic susceptibility profiles. Our patient was successfully treated with ciprofloxacin and ceftazidime with the final vision of 20/40.

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.