Dr.Hythum S. Mohamed KAMC-Riyadh-February 2015

Case Presentation Chryseobacterium Indologenes Pneumonia

25 years old female presented to the ER department in November 2014 with complaints of fever , cough and shortness of breath .

She was admitted as a case of CAP . She has PMH of ESRD on regular haemodialysis . After short stay in ER she had being unstable and transferred to the ICU . Blood and sputum cultures showed growth of MSSA. Pt improved after receiving Antibiotics and then transferred to the word after

about one week of ICU admission . After about one week of admission in the word she developed symptoms of HAP

and being unstable and then she needed ICU admission again .

In ICU she required mechanical ventilator after short stay . Full septic screening including MERS-COV , TB screening was done and apart

from positive respiratory culture all were negative. Chest X-Ray showed bilateral infiltration more in the right side and pleural

effusion . CT-Chest showed diffuse right lung opacity keeping with pneumonia , bilateral

pleural effusion small amount in the right side and moderate and loculated in the left side and also cavity lesion in the left lower lung .

Diagnosis was sever HAP ( Necrotizing Pneumonia ? +Empyema).

Surgical treatment was done for Pt ( left upper and lower wedge resection + chest tube ) + multiple antibiotics but not improved .

pt improved after received definitive antibiotics . pt discharged from Hospital in a good condition after 41 days of admission .

Respiratory Cultures ( Sputum and Tracheal aspirate ) showed Chryseobacterium Indologenes which was sensitive to (Cefepime, ciprofloxacin and Bactrim ) , resistant to (Imipenem , Meropenem , Piperacilin/ tazobactam , Amikacin and Gentamycin ) and intermediate to Ceftazidime .

During admission pt received Antimicrobials as :-Ceftriaxone, Azithromycin , Moxifloxacin , Tazocin , Tameflu , Vancomycin , Linzolid , Meropenem , Imipenem , Colstine , Cloxacillin sodium , Gentamycin , Metronidazole ,Bactrim and Ciprofloxacin . Pt improved on Bactrim + Ciprofloxacin for 12 days .

Chryseobacterium is a genus of Gram negative,nonmotile,oxidase- and indole-positive aerobic bacilli .

normally found in plants, soil, foodstuffs, and fresh and marine water sources.

It can survive in chlorine-treated water supplies, which can lead to reservoirs for hospital-acquired infections.

Chryseobacterium indologenes was first isolated from the tracheal aspirate of a patient with ventilator-associated pneumonia in 1993.

Chryseobacterium