Presentation Title

Case Report of Pediatric Patient with Citrobacter koseri Bacteremia and Leptomeningeal Enhancements

Speaker Credentials

P2

Speaker Credentials

DO

Format

Poster

Start Date

6-11-2020 11:15 AM

End Date

6-11-2020 11:30 AM

Abstract

Case Report of Pediatric Patient with Citrobacter koseri Bacteremia and Leptomeningeal Enhancements Amanda Sturgill, DO1, Shivani Patel, DO1, Annette Santiago, MD2 1Pediatrics, Palms West Hospital 2Pediatric Hospitalist, Palms West Hospital Introduction. Citrobacter bacteremia causes brain abscesses in neonates and immunocompromised patients1. Citrobacter koseri has higher virulence once opportunistic infection occurs, possibly allowing its spread to the brain compared to other Citrobacter species2. Case Description. 15 mo M PMH Gastroschisis, Short Gut Syndrome, G-tube Dependence, TPN Dependence, and Prematurity presented to another facility for fever, vomiting, and bloody diarrhea. Work-up showed neutropenia and dehydration. He was admitted and the neutropenia and diarrhea resolved, however positive blood cultures resulted x3 for Citrobacter koseri and x1 for Pseudomonas aeruginosa. He received 5 days of Ceftriaxone and one dose of Piperacillin-Tazobactam prior to transfer. After arrival, he continued Piperacillin-Tazobactam. Given positive blood cultures for Citrobacter koseri, patient underwent MRI Brain which showed mildly prominent leptomeningeal enhancement overlying the bilateral frontal convexities. Lumbar Puncture was performed. CSF analysis was unremarkable and culture was negative. Piperacillin-Tazobactam was switched to Meropenem for better CNS penetration. Due to continued positive blood cultures of Pseudomonas and then Enterococcus, Vancomycin was added during his course. He completed 21 days of Meropenem and 16 days of Vancomycin before being discharged home. Discussion. This patient was neither a neonate nor grossly immunocompromised but was prone to opportunistic infection due to his indwelling port being accessed daily, his G-tube dependence, and his history of Short Gut Syndrome. While Citrobacter positive culture may represent contamination, rarely brain abscesses can develop. Therefore, repeat cultures should be performed and contrast-enhanced neuroimaging should be considered to evaluate for abscess as findings will dictate treatment length and modality. Townsend SM, Pollack HA, Gonzalez-Gomez I, Shimada H, Badger JL. Citrobacter koseri brain abscess in the neonatal rat: survival and replication within human and rat macrophages. Infect Immun. 2003;71(10):5871-5880. doi:10.1128/iai.71.10.5871-5880.2003. Yuan C, Yin Z, Wang J, et al. Comparative Genomic Analysis of Citrobacter and Key Genes Essential for the Pathogenicity of Citrobacter koseri. Front Microbiol. 2019;10:2774. Published 2019 Dec 6. doi:10.3389/fmicb.2019.02774. This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

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Nov 6th, 11:15 AM Nov 6th, 11:30 AM

Case Report of Pediatric Patient with Citrobacter koseri Bacteremia and Leptomeningeal Enhancements

Case Report of Pediatric Patient with Citrobacter koseri Bacteremia and Leptomeningeal Enhancements Amanda Sturgill, DO1, Shivani Patel, DO1, Annette Santiago, MD2 1Pediatrics, Palms West Hospital 2Pediatric Hospitalist, Palms West Hospital Introduction. Citrobacter bacteremia causes brain abscesses in neonates and immunocompromised patients1. Citrobacter koseri has higher virulence once opportunistic infection occurs, possibly allowing its spread to the brain compared to other Citrobacter species2. Case Description. 15 mo M PMH Gastroschisis, Short Gut Syndrome, G-tube Dependence, TPN Dependence, and Prematurity presented to another facility for fever, vomiting, and bloody diarrhea. Work-up showed neutropenia and dehydration. He was admitted and the neutropenia and diarrhea resolved, however positive blood cultures resulted x3 for Citrobacter koseri and x1 for Pseudomonas aeruginosa. He received 5 days of Ceftriaxone and one dose of Piperacillin-Tazobactam prior to transfer. After arrival, he continued Piperacillin-Tazobactam. Given positive blood cultures for Citrobacter koseri, patient underwent MRI Brain which showed mildly prominent leptomeningeal enhancement overlying the bilateral frontal convexities. Lumbar Puncture was performed. CSF analysis was unremarkable and culture was negative. Piperacillin-Tazobactam was switched to Meropenem for better CNS penetration. Due to continued positive blood cultures of Pseudomonas and then Enterococcus, Vancomycin was added during his course. He completed 21 days of Meropenem and 16 days of Vancomycin before being discharged home. Discussion. This patient was neither a neonate nor grossly immunocompromised but was prone to opportunistic infection due to his indwelling port being accessed daily, his G-tube dependence, and his history of Short Gut Syndrome. While Citrobacter positive culture may represent contamination, rarely brain abscesses can develop. Therefore, repeat cultures should be performed and contrast-enhanced neuroimaging should be considered to evaluate for abscess as findings will dictate treatment length and modality. Townsend SM, Pollack HA, Gonzalez-Gomez I, Shimada H, Badger JL. Citrobacter koseri brain abscess in the neonatal rat: survival and replication within human and rat macrophages. Infect Immun. 2003;71(10):5871-5880. doi:10.1128/iai.71.10.5871-5880.2003. Yuan C, Yin Z, Wang J, et al. Comparative Genomic Analysis of Citrobacter and Key Genes Essential for the Pathogenicity of Citrobacter koseri. Front Microbiol. 2019;10:2774. Published 2019 Dec 6. doi:10.3389/fmicb.2019.02774. This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.