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Ndibarema ER, Olum R, Ogavu J, Makhoba A. A rare case of multi-drug resistant Raoultella ornithinolytica-induced sepsis in a healthy young man in Uganda. Clin Case Rep 2024; 12:e8402. [PMID: 38173896 PMCID: PMC10761617 DOI: 10.1002/ccr3.8402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/30/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
Key Clinical Message Antimicrobial resistance (AMR) is a public health challenge. It causes unresponsiveness to treatment with antimicrobials, leads to sepsis, septic shock, and increased hospital mortality. This is compounded by new multidrug resistant organisms. We present and discuss a case of sepsis caused by a rare multi-drug resistant bacterium Raoultella ornithinolytica. Abstract Antimicrobial resistance is a major public health concern worldwide, associated with nearly 5 million deaths. The highest mortality attributed to AMR is seen in sub-Saharan Africa. Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa contribute to most deaths attributed to AMR globally. However, other uncommon microorganisms have been implicated. Few cases of resistant, extended-spectrum beta-lactamase (ESBL) producing Raoultella ornithinolytica have been reported to cause sepsis worldwide. To our knowledge, no case of R. ornithinolytica-induced sepsis has been reported in our settings. We report a case of sepsis due to R. ornithinolytica in an injured young adult. We received a 36-year-old man, a professional banker involved in a road traffic accident 2 h before admission. He sustained a deep degloving wound on the right ankle with exposure of the lateral malleolus and presented with severe pain, and bleeding at the injury site. x-Rays confirmed a comminuted intra-articular distal tibia and fibular fracture. Surgical debridement and external fixation were aseptically done on the same day. Below knee amputation was done on the 7th day post-admission due to extensively injured and infected limb with sepsis. Local pus culture isolated ESBL-positive R. ornithinolytica susceptible only to meropenem, ciprofloxacin, and amikacin. Introducing these antibiotics on the 11th post-admission day averted sepsis and enhanced patient recovery. With the threat of AMR, newly emerging highly resistant microbes should be expected and suspected. Early recognition of sepsis and its focus and precise intervention with antimicrobials guided by specimen culture and susceptibility profile is highly recommended and should be standard practice. It highly reduces morbidity and mortality due to sepsis.
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Affiliation(s)
- Elias Rugaatwa Ndibarema
- Department of MedicineSt Francis Hospital NsambyaKampalaUganda
- Mother Kevin Postgraduate Medical School, School of MedicineUganda Martyrs UniversityKampalaUganda
| | - Ronald Olum
- Department of MedicineSt Francis Hospital NsambyaKampalaUganda
- School of Public HealthMakerere UniversityKampalaUganda
- School of Public HealthImperial College LondonUnited Kingdom
| | - Joseph Ogavu
- Department of MedicineSt Francis Hospital NsambyaKampalaUganda
- Mother Kevin Postgraduate Medical School, School of MedicineUganda Martyrs UniversityKampalaUganda
| | - Anthony Makhoba
- Department of MedicineSt Francis Hospital NsambyaKampalaUganda
- Mother Kevin Postgraduate Medical School, School of MedicineUganda Martyrs UniversityKampalaUganda
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2
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Koishi N, Sasano H, Yoshizawa T, Shikuri M, Matsumoto H, Suzuki M, Fukui Y, Chonan M, Kimura T, Ichida H, Saiura A, Naito T. Successful Treatment of a Case of Metallo-Beta-Lactamase-Producing Raoultella ornithinolytica Bacteremia by Antimicrobial Stewardship Team Intervention and Therapeutic Drug Monitoring-Based Amikacin Treatment. Case Rep Infect Dis 2023; 2023:5574769. [PMID: 37065978 PMCID: PMC10104729 DOI: 10.1155/2023/5574769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 04/18/2023] Open
Abstract
An 80-year-old woman underwent pancreatoduodenectomy. Post-operation, she experienced a fever, and a culture of blood revealed metallo-beta-lactamase-producing Raoultella ornithinolytica. For treatments with aminoglycoside antimicrobial agents, a therapeutic drug monitoring-based dosing design can lower the risk of adverse events and enable appropriate treatment. Key Clinical Message. When aminoglycoside antimicrobial agents are administered for MBL-producing bacteremia, prescription suggestions based on TDM by antimicrobial stewardship team can reduce the occurrence of adverse events and enable appropriate treatment.
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Affiliation(s)
- Noriko Koishi
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Hiroshi Sasano
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | | | - Mika Shikuri
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | | | - Mai Suzuki
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Yukiko Fukui
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Masayoshi Chonan
- Department of Clinical Laboratory, Juntendo University Hospital, Tokyo, Japan
| | - Toshimi Kimura
- Department of Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Hirofumi Ichida
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Akio Saiura
- Department of Hepatobiliary-Pancreatic Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
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3
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Analysis of Anti-Infective Treatment of 9 Neonates with Raoultella ornithinolytica Sepsis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:2424011. [PMID: 36185089 PMCID: PMC9519338 DOI: 10.1155/2022/2424011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 08/17/2022] [Indexed: 11/24/2022]
Abstract
Raoul ornithine-releasing bacteria widely exist in water, plants, and soil, and colonize the digestive tract and upper respiratory tract of the human body. They are aerobic, unpowered, and capsular opportunistic pathogens. The infectivity of this bacterium is still uncertain, but the possibility of nosocomial infection has been mentioned in the literature. Studies have pointed out that the bacterium should be diagnosed in time and sensitive antibiotics should be used early. Once complicated with sepsis, it can cause multiple organ failure with a poor prognosis. In this study, we retrospectively analyzed the clinical data of nine cases of neonatal L. ornithine septicemia, to explore the clinical characteristics of neonatal L. ornithine septicemia and anti-infection therapy.
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A case report of community-acquired Raoultella ornithinolytica infection in a healthy, young individual. BMC Infect Dis 2021; 21:1095. [PMID: 34689741 PMCID: PMC8542406 DOI: 10.1186/s12879-021-06799-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Raoultella ornithinolytica is a Gram-negative bacillus that resembles Klebsiella. This bacterium is present in many soil and aquatic environments and is a major causative agent of healthcare-associated infections (HAIs) in medical staff. Clinically, it has been reported to contribute to nosocomial infections in patients that include but are not limited to gastrointestinal, skin, and genitourinary tract infections. These complications are most common in hospitalized patients with underlying immunodeficiency, multiple comorbidities, or those receiving invasive surgery. CASE PRESENTATION We present a case of a 25-year-old patient with a R. ornithinolytica infection. The patient had no history of any disease. Her main complaints were high fever, a scattered maculopapular rash, and superficial lymph node enlargement (SLNE). Peripheral blood samples were collected for high-throughput sequencing analysis to identify pathogenic microorganisms. The results confirmed a R. ornithinolytica infection, which was treated successfully using meropenem. Loratadine was also administered to treat the patient's compromised skin condition caused by an allergic reaction. CONCLUSIONS To our knowledge, this is the first case of a systemic maculopapular rash and superficial lymphadenopathy caused by a R. ornithinolytica infection acquired at the community level. Based on this case, we recommend a combination of antibiotic and antiallergic drugs to treat a R. ornithinolytica infection and associated allergic reaction to the bacteria.
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5
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Abd El-Ghany WA. A spotlight on Raoultella ornithinolytica: A newly emerging life-threatening zoonotic pathogen. INTERNATIONAL JOURNAL OF ONE HEALTH 2021. [DOI: 10.14202/ijoh.2021.1-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The genus Raoultella contains Raoultella ornithinolytica (R. ornithinolytica), which was previously named as Klebsiella ornithinolytica. R. ornithinolytica is a Gram-negative bacillus that belongs to the family Enterobacteriaceae. This pathogen is normally present in aquaculture, and it has been isolated from fish, insects, and wild and domestic birds. Seafood and poultry products are incriminated as sources of R. ornithinolytica infection. Community-acquired human infection with R. ornithinolytica is common. This infection is commonly associated with sepsis, bacteremia, food poisoning, purities, and urinary and respiratory tracts' infections. Rapid acquired resistance of R. ornithinolytica strains is common, and it is related to the development of resistant genes. R. ornithinolytica is considered as a newly emerging life-threatening pathogen world-wide. Hence, it is very important to determine the role of animals and birds in the epidemiological situation of this pathogen as well as the detection of antibiotic resistance genes before treatment.
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Affiliation(s)
- Wafaa A. Abd El-Ghany
- Department of Poultry Diseases, Faculty of Veterinary Medicine, Cairo University, Egypt
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6
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Karacı M, Yaşar A. URINARY STONE RELATED URINARY TRACT INFECTION CAUSED BY RAOULTELLA ORNITHINOLYTICA IN A CHILD: A CASE REPORT. Acta Clin Croat 2020; 59:751-753. [PMID: 34285447 PMCID: PMC8253079 DOI: 10.20471/acc.2020.59.04.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022] Open
Abstract
Raoultella ornithinolytica is one of the three species of Raoultella. The present case report describes a two-year-old child who had complaints of discomfort and fever, and Raoultella ornithinolytica in his urinary culture. Grade-2 hydronephrosis and a 7.5-mm urinary stone were detected in the patient’s left ureter. The stone was expelled upon consultation with pediatric urology department. The patient was treated according to culture antibiotic sensitivity report and continued to be followed-up.
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Affiliation(s)
| | - Adem Yaşar
- 1University of Medical Sciences, Şehit Prof. Dr. İlhan Varank Sancaktepe Training and Research Hospital, Department of Pediatrics. Istanbul, Turkey; 2Celal Bayar University, Faculty of Medicine, Department of Pediatrics, Allergy and Immunology, Manisa, Turkey
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7
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El-Shannat SM, El-Tawab AAA, Hassan WMM. Emergence of Raoultella ornithinolytica isolated from chicken products in Alexandria, Egypt. Vet World 2020; 13:1473-1479. [PMID: 32848326 PMCID: PMC7429399 DOI: 10.14202/vetworld.2020.1473-1479] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/04/2020] [Indexed: 11/30/2022] Open
Abstract
Background and Aim: Raoultella ornithinolytica is one of the emerging gram-negative bacteria, which associated with foodborne illness. Researches affirmed that distinguish between R. ornithinolytica and Klebsiella oxytoca are difficult, as they are phylogenetic related. The evolution of multidrug resistance of Raoultella strains gained more concern for recognition of the pathogen which supports in controlling the disease and minify its threat. This study sought to find a reliable tool for the identification of Raoultella ornithinolytica, isolated from chicken product samples, and assessed the resistance profile of R. ornithinolytica using antibiogram sensitivity tests. Materials and Methods: Forty samples of chicken products were collected between January and September 2019 from different markets in Alexandria Governorate, Egypt. The products included nuggets, strips, burgers, luncheon meats, pane, frankfurters, and minced chicken meat. The samples were transferred to the Reference Laboratory. The samples were subjected to isolation, biochemical reaction testing, phenotypic system analytical profile index (API) E20, and a detection of antimicrobial susceptibility test. Phenotypic identification was confirmed through matrix-assisted laser-desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS). Results: Thirty-three bacterial isolates (82.50%) out of 40 samples were isolated into pure cultures from the chicken samples. Three isolates (9.09%) were positive for R. ornithinolytica, while 30 isolates (90.91%) exhibited growth characters for different pathogens (Escherichia coli, Enterobacter aerogenes, Proteus vulgaris, R. ornithinolytica, and Klebsiella pneumoniae). The isolates of R. ornithinolytica were resistant to five types of antibiotics and sensitive to two types of antibiotics. Conclusion: This study reported the first case of R. ornithinolytica found in chicken products in Egypt. Phenotypic system API 20E and MALDI-TOF MS were found to be reliable tools for confirming the diagnosis of R. ornithinolytica. As it provides rapid identification with high sensitivity and specificity for R. ornithinolytica, which often do not require a molecular procedure for confirmation.
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Affiliation(s)
- Sara M El-Shannat
- Department of Microbiology, Animal Health Research Institute, Marsa Matruh, Egypt
| | - Ashraf A Abd El-Tawab
- Department of Bacteriology, Immunology, and Mycology, Faculty of Veterinary Medicine, Benha University, Banha, Egypt
| | - Wafaa M M Hassan
- The Reference Laboratory for Quality Control on Poultry Production, Animal Health Research Institute, Dokki, Giza, Egypt
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8
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Hajjar R, Ambaraghassi G, Sebajang H, Schwenter F, Su SH. Raoultella ornithinolytica: Emergence and Resistance. Infect Drug Resist 2020; 13:1091-1104. [PMID: 32346300 PMCID: PMC7167274 DOI: 10.2147/idr.s191387] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 12/13/2019] [Indexed: 11/23/2022] Open
Abstract
Raoultella ornithinolytica is an encapsulated Gram-negative, oxidase-negative, catalase-positive, aerobic, non-motile rod that belongs to the Enterobacteriaceae family. This bacterium was initially classified in the genus Klebsiella as Klebsiella ornithinolytica, until the creation of the genus Raoultella in 2001. R. ornithinolytica is usually found in water environments and soil, and due to its ability to convert histidine to histamine, it has been associated with histamine poisoning in humans. R. ornithinolytica is an emerging entity in human infections, with several reports of virulent infections in comorbid at-risk patients. Increasing reports are potentially due to better and more precise identification tools. The objective of this article is to provide a comprehensive review of reported cases of R. ornithinolytica infections, the emergent virulence of described multiresistant strains, and an overview of currently used identification methods.
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Affiliation(s)
- Roy Hajjar
- Digestive Surgery Service, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Georges Ambaraghassi
- Department of Medical Microbiology and Infectious Diseases, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Herawaty Sebajang
- Digestive Surgery Service, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Frank Schwenter
- Digestive Surgery Service, Department of Surgery, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Shih-Hann Su
- Department of Medical Microbiology and Infectious Diseases, Centre Hospitalier de l'Université de Montréal (CHUM), Montréal, Québec, Canada
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9
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Sêkowska A, Bogiel T, Woźniak M, Gospodarek-Komkowska E. Raoultella spp. – reliable identification, susceptibility to antimicrobials and antibiotic resistance mechanisms. J Med Microbiol 2020; 69:233-238. [DOI: 10.1099/jmm.0.001150] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Alicja Sêkowska
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Tomasz Bogiel
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Marcin Woźniak
- Department of Forensic Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Eugenia Gospodarek-Komkowska
- Department of Microbiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, Toruń, Poland
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10
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Pi DD, Zhou F, Bai K, Liu C, Xu F, Li J. Raoultella ornithinolytica Infection in the Pediatric Population: A Retrospective Study. Front Pediatr 2020; 8:362. [PMID: 32754562 PMCID: PMC7366290 DOI: 10.3389/fped.2020.00362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022] Open
Abstract
Raoultella ornithinolytica is a pathogen causing an increasing number of pediatric infections. The objective of this study was to investigate the clinical characteristics of R. ornithinolytica infections in children. As a retrospective analysis, clinical features and drug susceptibility data of the five cases were analyzed and related literature was reviewed. A total of 14 cases (eight females, six males) were analyzed: nine cases were retrieved from PubMed, Web of Science, and three domestic databases; five cases occurred in our hospital. The primary diseases of the older children were mainly of neoplastic and immune origin, while cases of infants and young children were mostly complicated by congenital malformation. Fever was the main symptom, and neonatal infection was mainly manifested by dyspnea and hypoxemia, with multiple skin flushes, systemic erythema, and leukocytosis. Of the 14 cases, six were ventilator-assisted, five had indwelling urethral catheters, three had surgical treatment or chemotherapy, and one had multiple rounds of continuous renal replacement therapy (CRRT). Blood infection is the main route of R. ornithinolytica infection in children. Skin flushing and systemic erythema might be positive clues for newborn infection. Patients with multiple congenital abnormalities are susceptible to infection. Tumors, immune deficiency, and invasive operations increase the risk of infection. Blood culture was the main method of disease identification. Based on the drug susceptibility results, the preferred antibiotics are third generations of cephalosporins, carbapenems, quinolone, and aminoglycoside. Lastly, patients with sepsis mostly have poor prognosis.
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Affiliation(s)
- Dan-Dan Pi
- Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Fang Zhou
- Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ke Bai
- Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Chengjun Liu
- Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Xu
- Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jing Li
- Intensive Care Unit, Children's Hospital of Chongqing Medical University, Chongqing, China.,Ministry of Education Key Laboratory of Child Development and Disorders, National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Children's Hospital of Chongqing Medical University, Chongqing, China
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11
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Wang S, Xu L, Chi X, Li Y, Kou Z, Hou P, Xie H, Bi Z, Zheng B. Emergence of NDM-1- and CTX-M-3-Producing Raoultella ornithinolytica in Human Gut Microbiota. Front Microbiol 2019; 10:2678. [PMID: 31824461 PMCID: PMC6883284 DOI: 10.3389/fmicb.2019.02678] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/05/2019] [Indexed: 12/21/2022] Open
Abstract
Raoultella ornithinolytica is an opportunistic pathogen of the Enterobacteriaceae family and has been implicated in nosocomial infections in recent years. The aim of this study was to characterize a carbapenemase-producing R. ornithinolytica isolate and three extended-spectrum β-lactamase (ESBL)-producing R. ornithinolytica isolates from stool samples of adults in a rural area of Shandong Province, China. The species were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S rDNA sequence analysis. Antimicrobial susceptibility test showed that all four isolates were multidrug-resistant (MDR). The whole genome sequence (WGS) of these isolates was determined using an Illumina HiSeq platform, which revealed MDR-related genes. The S1 nuclease-pulsed-field gel electrophoresis (S1-PFGE) was used to characterize the plasmids carried by the R. ornithinolytica isolates. The blaNDM-1 and blaCTX-M-3 genes were probed using Southern blotting, which confirmed the location of both genes on the same plasmid with molecular weight of 336.5–398.4 kb. The transferability of blaNDM-1 and blaCTX-M was also confirmed by conjugation assays. Finally, BLAST analysis of both genes showed that mobile genetic elements were associated with the spread of drug resistance genes. Taken together, we report the presence of conjugative blaNDM-1 and blaCTX-M plasmids in R. ornithinolytica isolates from healthy humans, which indicate the possibility of inter-species transfer of drug resistance genes. To the best of our knowledge, this is the first study to isolate and characterize carbapenemase-producing R. ornithinolytica and ESBL-producing R. ornithinolytica isolates from healthy human hosts.
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Affiliation(s)
- Shuang Wang
- Bacterial Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Liuchen Xu
- Bacterial Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xiaohui Chi
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.,Department of Environment and Health, School of Public Health, Shandong University, Jinan, China
| | - Yan Li
- Bacterial Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Zengqiang Kou
- Bacterial Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Peibin Hou
- Bacterial Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Hengjie Xie
- Department of Supervise Sampling, Shandong Institute for Food and Drug Control, Jinan, China
| | - Zhenwang Bi
- Bacterial Infection Disease Control of Institute, Shandong Center for Disease Control and Prevention, Jinan, China.,Shandong Academy of Clinical Medicine, Shandong Provincial Hospital, Jinan, China
| | - Beiwen Zheng
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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12
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De Petris L, Ruffini E. Roultella ornithinolytica infection in infancy: a case of febrile urinary tract infection. CEN Case Rep 2018; 7:234-236. [PMID: 29721836 PMCID: PMC6181883 DOI: 10.1007/s13730-018-0333-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 04/23/2018] [Indexed: 10/17/2022] Open
Abstract
Raoultella ornithinolytica is a Gram-negative, non-motile, encapsulated, aerobic bacillus belonging to the Enterobacteriaceae family. R. ornithinolytica is a not very common, but emergent causal agent of human infection, and its expression of beta-lactamase provides resistance to commonly used antibiotics. The pathogenetic potential of R. ornithinolytica isolates in human disease has become increasingly important. Several cases of hospital-acquired infection, mostly associated with invasive procedures, or in patients with co-morbidity caused by R. ornithinolytica, have been previously reported in the adult population. In pediatric population, two cases in immunocompromised children, one case in an infant with visceral heterotaxy and one case of catheter-related bacteraemia are described. Here, we present the first case of febrile urinary tract infection due to R. ornithinolytica in an 8-month-old infant, recovered from a previous febrile UTI caused by E. coli and without co-morbidity. The empiric therapy with ceftriaxone, followed by cefpodoxime proxetil, resolved symptoms: the clinical condition of the infant improved rapidly and the treatment eradicated urine from the R. ornithinolytica infection. Since other pathogens rather than R. ornithinolytica are usually identified in children with urinary tract infections, including Escherichia coli, Proteus, Klebsiella and Pseudomonas, the identification of this microorganism in our patient's urine was also unexpected.
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Affiliation(s)
- Laura De Petris
- Department of Pediatrics and Neonatology, "G. Mazzoni" Hospital, Via Degli Iris, 1, 63100, Ascoli Piceno, Italy.
| | - Ermanno Ruffini
- Department of Pediatrics and Neonatology, "G. Mazzoni" Hospital, Via Degli Iris, 1, 63100, Ascoli Piceno, Italy
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13
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Ayoade F, Mada PK, Alam M. Fat necrosis and polymicrobial wound infection caused partly by Raoultella ornithinolytica after reduction mammoplasty. BMJ Case Rep 2018; 2018:bcr-2018-224234. [PMID: 29866679 DOI: 10.1136/bcr-2018-224234] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Raoultella ornithinolytica is a rare opportunistic aerobic gram-negative bacillus that naturally exists in soil, water and plants. The pathogen has been described in association with diabetic foot infections, biliary infections, bacteraemia and native and prosthetic joint infections. Fat necrosis and wound infection following breast reduction surgery or other plastic surgeries caused by this pathogen have not been previously described. We present a case of bilateral fat necrosis, wound infection and dehiscence in a 24-year-old woman with no significant past medical problems. She initially had an uneventful early postoperative course but 3 weeks after surgery noticed pain and discharge from both nipple/areola area of both breasts which later developed into full-thickness fat necrosis and complete destruction of the nipple areolar complex. R. ornithinolytica, Escherichia coli and Enterococcus faecalis were identified from wound exudate cultures. She was treated with surgical debridement and 2 weeks of appropriate antibiotics with a favourable outcome.
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Affiliation(s)
- Folusakin Ayoade
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Pradeep Kumar Mada
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Mohammad Alam
- Division of Infectious Diseases, Department of Medicine, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
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Marietto-Gonçalves GA, Lima EL, Nagayoshi BA, Tonin AA, Knöbl T, Adreatti Filho RL. Raoultella ornithinolytica Isolation in Cloacal Microbiota of Tinamus solitarius: Preliminary Data. BRAZILIAN JOURNAL OF POULTRY SCIENCE 2018. [DOI: 10.1590/1806-9061-2017-0599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
| | | | | | - AA Tonin
- Instituto Federal de Ciências e Tecnologia do Amazonas, Brazil
| | - T Knöbl
- Universidade de São Paulo, Brazil
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15
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González-Castro A, Rodríguez-Borregán JC, Campos S, Pérez Canga JL. Catheter-related bacteraemia caused by Raoultella ornithinolytica. ACTA ACUST UNITED AC 2017; 65:116-118. [PMID: 29162280 DOI: 10.1016/j.redar.2017.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 09/17/2017] [Accepted: 09/18/2017] [Indexed: 11/29/2022]
Abstract
Infections in humans by Raoultella spp. are rare and the effect that Raoultella spp. might have as a human pathogen is currently unknown. A clinical case is presented of catheter-related bacteraemia caused by Raoultella ornithinolytica, treated successfully with applied antibiotic therapy (intravenous cefepime and sealed the catheter with amikacin).
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Affiliation(s)
- A González-Castro
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - J C Rodríguez-Borregán
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - S Campos
- Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - J L Pérez Canga
- Servicio de Nefrología, Hospital Universitario Marqués de Valdecilla, Santander, España
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16
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Jellinge ME. Raoultella Ornithinolytica Diagnosed in a Neurointensive Patient. A Rare Case with Recovery without Antibiotics. ACTA ACUST UNITED AC 2017; 3:120-122. [PMID: 29967883 PMCID: PMC5769903 DOI: 10.1515/jccm-2017-0017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 05/05/2017] [Indexed: 11/15/2022]
Abstract
Infection with Raoultella ornithinolytica is rare and normally the infection is present in patients with underlying malignancies or chronic diseases. It is normally treated with antibiotics. In this case report, a neuro-intensive patient without malignancies or other severe chronic diseases was colonized with Pseudomonas aeruginosa but infected with Raoultella ornithinolyca. The patient recovered without treatment with antibiotics.
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Affiliation(s)
- Marlene Ersgaard Jellinge
- Department of Anesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
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17
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Sękowska A. Raoultella spp.-clinical significance, infections and susceptibility to antibiotics. Folia Microbiol (Praha) 2017; 62:221-227. [PMID: 28063019 DOI: 10.1007/s12223-016-0490-7] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/29/2016] [Indexed: 12/11/2022]
Abstract
The genus Raoultella belongs to the family of Enterobacteriaceae. Raoultella spp. are Gram-negative, aerobic, non-motile rods. This genus can be distinguished from the genus Klebsiella, in that genus use histamine as the only source of carbon in the medium. Also, Raoultella grow at 4 °C and do not produce gas from lactose at 44.5 °C. Raoultella sp. is known to inhabit natural environments (water, soil, plants). The reservoir of Raoultella is the gastrointestinal tract and upper respiratory tract. Raoultella spp. are opportunistic bacteria, which usually cause infections of the biliary tract, pneumonia and bacteraemia in oncologic and with lower immunity patients. Raoultella planticola and Raoultella ornithinolytica are the most frequently encountered human pathogens among the genus Raoultella. In this review, the current knowledge on Raoultella infections is summarized.
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Affiliation(s)
- Alicja Sękowska
- Department of Microbiology, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, M. Skłodowskiej-Curie 9, 85-094, Bydgoszcz, Poland.
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Seng P, Boushab BM, Romain F, Gouriet F, Bruder N, Martin C, Paganelli F, Bernit E, Le Treut YP, Thomas P, Papazian L, Raoult D, Stein A. Emerging role of Raoultella ornithinolytica in human infections: a series of cases and review of the literature. Int J Infect Dis 2016; 45:65-71. [PMID: 26921549 DOI: 10.1016/j.ijid.2016.02.014] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Revised: 02/16/2016] [Accepted: 02/18/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Raoultella ornithinolytica is known to inhabit aquatic environments. The clinical features and outcomes of human infections caused by R. ornithinolytica have been reported for only a limited number of cases. METHODS A retrospective study of cases of infection caused by R. ornithinolytica managed at four university hospital centres during the period before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed. The aim was to describe the clinical and microbiological characteristics, treatments, and outcomes. RESULTS Among 187 R. ornithinolytica isolates identified for which clinical information was available, 71 were considered colonizers and 116 were pathogenic. A total of 112 cases of R. ornithinolytica infection were identified. Urinary tract infections, gastrointestinal infections, wound and skin infections, and bacteraemia were observed in 36%, 14%, 13%, and 5% of cases, respectively. Associated infections that have been poorly reported, such as respiratory infections, i.e. pneumonia and pleural effusion, were observed in 24% of cases. Additional diseases reported here for the first time included osteomyelitis, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis, and otitis. The proportion of R. ornithinolytica isolates resistant to antibiotics was found to be relatively high: 4% of isolates were resistant to ceftriaxone, 6% to quinolones, and 13% to co-trimoxazole. The mortality rate related to infection was 5%. CONCLUSIONS R. ornithinolytica is an underreported, emerging hospital-acquired infection and is particularly associated with invasive procedures. R. ornithinolytica should never be considered simply a saprophytic bacterium that occasionally contaminates bronchial lavage or other deep respiratory samples or surgical sites. Physicians should be aware of the high rates of antimicrobial resistance of R. ornithinolytica isolates so that immediate broad-spectrum antibiotic treatment can be established before accurate microbiological results are obtained.
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Affiliation(s)
- Piseth Seng
- Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France.
| | - Boushab Mohamed Boushab
- Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France
| | - Fanny Romain
- Service d'Informatique Médicale, Hôpital de la Conception, Marseille, France
| | | | - Nicolas Bruder
- Département d'Anesthésie-réanimation et Soins Intensif, Hôpital de la Timone, Marseille, France
| | - Claude Martin
- Service d'Anesthésie et de Réanimation, Hôpital Nord, Marseille, France
| | | | - Emmanuelle Bernit
- Département de Médecine Interne, Hôpital de la Conception, Marseille, France
| | - Yves Patrice Le Treut
- Département de Chirurgie Digestive et Transplantation Hépatique, Hôpital de la Conception, Marseille, France
| | - Pascal Thomas
- Département de Chirurgie Thoracique, Transplantation Pulmonaire et Maladies Respiratoires, Hôpital Nord, Marseille, France
| | - Laurent Papazian
- Réanimation Médicale Détresses Respiratoires - Infections Sévères, Hôpital Nord, Marseille, France
| | - Didier Raoult
- Aix-Marseille Université, Faculté de Médecine, Marseille, France
| | - Andreas Stein
- Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France
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19
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[Sepsis caused by Raoultella ornithinolytica in an immunocompetent patient]. Anaesthesist 2016; 65:129-33. [PMID: 26811948 DOI: 10.1007/s00101-015-0130-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 12/01/2015] [Accepted: 12/08/2015] [Indexed: 12/29/2022]
Abstract
Raoultella ornithinolytica is a species of gram-negative encapsulated and aerobic bacteria belonging to the family Enterobacteriaceae and is mainly found in fish. The most distinctive feature of this bacterium is the ability to convert histidine to histamine; therefore, the consumption of decomposing fish infected by R. ornithinolytica causes rashes, diarrhea, flushing, sweating and vomiting. This food poisoning is also called histamine fish poisoning; however, human infections with R. ornithinolytica are extremely rare and have so far only affected patients with diseases suppressing the immune system. The current case report describes for the first time sepsis with evidence of bloodstream infection by R. ornithinolytica in an immunocompetent male patient and the successful antibiotic treatment.
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