Byline: Puneet. Gupta, Suma. Appannanavar, Harsimran. Kaur, Vikas. Gupta, Balvinder. Mohan, Neelam. Taneja
Infections caused by Brevundimonas vesicularis, a nonfermenting Gram-negative bacterium, are very rare. Here, we report the first case of multidrug-resistant hospital acquired urinary tract infection by B. vesicularis. Patient was successfully treated with antimicrobial therapy with piperacillin-tazobactam and amikacin.
The genus Brevundimonas is classified in the rRNA group 4 of Pseudomonas . Of the nine species in this genus, Brevundimonas vesicularis , Brevundimonas diminuta , and Brevundimonas nasdae are implicated as rare causes of human infections. [sup], Infection is either hospital or community acquired. [sup], Previously Brevundimonas infections have been reported from cases of bacteremia, skin and soft tissue infections, liver abscess, meningitis, peritonitis, septic arthritis, keratitis, and endocarditis. [sup],,,, To the best of our knowledge, we have found only a single case of urinary tract infection (UTI) caused by B. diminuta . [sup] Here, we present the first case report of hospital acquired UTI caused by multidrug-resistant B. vesicularis .
A 24-year-old male patient presented to the emergency department with history of sudden onset of pain in the abdomen of 1 week duration. The pain was moderate to severe in intensity and was associated with nonbilious nonprojectile vomiting with decreased urinary output. Patient had shortness of breath but no orthopnea or paroxysmal nocturnal dyspnea. There was no history suggestive of upper and lower gastrointestinal bleed, UTI, hypertension, diabetes mellitus, and tuberculosis. Patient also gave a history of consumption of alcohol (about 250 ml daily) for last 3-4 years. Initial investigation revealed the following values: serum urea 157 mg/dl, creatinine 6.8 mg/dl, and amylase 1058 U/L. He was diagnosed as a case of severe pancreatitis with acute kidney injury and acute respiratory illness and was managed conservatively. During the hospital stay, he started developing pleural effusion and ascites. His condition started deteriorating and finally on the 40 [sup]th day of admission, an exploratory laparotomy and necrosectomy of body and tail of pancreas was performed. The lesser sac drain, pelvic drain, and per urethral catheter were left in situ postoperatively. Candida tropicalis was isolated from the intraoperative fluid...