Abstract
Background: Raoultella planticola is a gram-negative rod-shaped bacterium commonly found in water and soil and considered to be a rare and possibly underestimated cause of severe human infection. Its presence should be suspected in older patients with a history of cancer, immune suppression and recent exposure to traumatic injuries or invasive medical procedures. Case presentation: A 78-year-old male with a history of hypertension was diagnosed with pancreatic adenocarcinoma. Whipple procedure (pancreaticoduodenectomy) was performed afterwards. On the 8th day of surgery, the patient was admitted to our tertiary ICU with septic shock. His initial Sequential Organ Failure Assessment (SOFA) score was 12 with predicted mortality 95.7%. Empirical antibiotic therapy with colymicin, meropenem and teikoplanin was administered immediately and two sets of blood cultures were obtained. Patient developed refractory septic shock despite the addition of vasopressin and the patient’s condition continued to deteriorate. Patient died on the third day of sepsis. His blood culture was positive for R. planticola, which was identified using the VITEK-2 biochemical identification system. Conclusions: Clinicians should be aware of fatal unusual infections in immunocompromised patients.
Highlights
Its presence should be suspected in older patients with a history of cancer, immune suppression and recent exposure to traumatic injuries or invasive medical procedures
His blood culture was positive for R. planticola, which was identified using the VITEK-2 biochemical identification system
The first case report of R. planticola infection was described by Freney et al in Lyon, France, of 69-year-old patient with R. planticola bacteremia who was admitted to an intensive care unit 9 days following a mitral valve replacement and was treated with cefotaxim and tobramycin [3]
Summary
Oral in water and soil and considered to be a rare and possibly underestimated cause of severe human infection [1]. It was previously described as Klebsiella planticola and K. trevisanii; relatively recently these two were combined into single species in 1986, i.e., K. planticola, based on DNA-DNA homology. R. planticola is mainly an aquatic and soil bacterium, it has been clinically isolated from human sputum, stool, wounds, and urine. Its presence should be suspected in older patients with a history of cancer, immune suppression and recent exposure to traumatic injuries or invasive medical procedures. We report a Raoultella planticola induced fatal sepsis in an immunocompromised patient with pancreatic cancer
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