A Case of Sphingobacterium multivorum Bloodstream Infection in a Critically-Ill Patient.

Abstract

Sir, Sepsis in intensive care units (ICUs) is common in immunocompromised individuals; herein, we discuss with the help of a case of sepsis due to Sphingobacteriummultivorum in an uncontrolled diabetic individual. A 40-year-old male with poorly controlled diabetes mellitus presented to our ICU with right thigh cellulitis and diabetic ketoacidosis (DKA). Subsequently, he developed inferior wall myocardial infarction and right ventricular dysfunction. On examination, he was in altered sensorium, hemodynamically unstable, and had respiratory distress. He was managed for all the above-mentioned issues, which comprised management of DKA and acute coronary syndrome (dual anti-platelets, heparin, statins) and included life support therapies in the form of invasive mechanical ventilation, central line placement, IV fluid resuscitation (guided by two-dimensional echocardiography, lung ultrasonography, and hemodynamic and oxygenation parameters), vasoactive drugs and other drugs such as anti-platelets, therapeutic heparinization, and IV insulin infusion for glycemic control (with emphasis on electrolytes also). The patient stayed in ICU for a prolonged period due to neuromuscular weakness, nosocomial infections, and ischemic cardiomyopathy. Later on, he developed a grade III sacral bedsore also. One of the bugs was S. multivorum cultured from his peripheral blood during an episode of high-grade fever. S. multivorum is a rare but important cause of bloodstream infection in critically ill populations. The bacterium is categorized under the genus Sphingobacterium (formerly known as Flavobacterium) are nonfermenting, catalase and oxidase positive, nonmotile, nonspore-forming Gram-negative rod, naturally found in soil, water, and plant materials.[1] Their nomenclature is secondary to the presence of large quantities of cellular sphingolipids. These rarely cause human diseases, but still, there are certain case reports about their association with infections like respiratory tract infections in patients with cystic fibrosis, soft-tissue infections, septicemia in hemodialysis patients, and meningitis.[2] The two species most commonly implicated are S. spiritivorum and S. multivorum. These are commonly found as commensals on human skin and predispose immunocompromised individuals to infections. However, there are case reports published about Sphingobacterium leading to cellulitis in an immunocompetent person also. In this patient, the isolate was S. multivorum which had led to bacteremia after 6 weeks of ICU stay. To our knowledge, this is the third rare case from India regarding S. multivorum infection in health-care settings. The probable source could have been the grade IV infected sacral bedsore. The bacterium was sensitive to piperacillin/tazobactam and levofloxacin and was resistant to ceftazidime, amikacin, imipenem, carbapenem, and aztreonam. The patient was also sensitive to trimethoprim/sulfamethoxazole (TMP/SMX) and was treated with (TMP/SMX). Sensitivity to other antibiotics was not done. The sensitivity profile of S. multivorum in some case reports depicts in Table 1.Table 1: Sensitivity of sphingobacterium multivorum isolates in case reportsThe information given in our case may be helpful in broadening our knowledge about infections with such bacteria. As these bacteria are rarely causative, though they have the capability to cause infection in immunocompetent individuals, hence these bacteria cannot be fully ignored. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patient understands that his name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.