Sepsis Caused by Chryseobacterium Indologenes in a Patient With Hydrocephalus

Abstract

Chryseobacterium (formerly Flavobacterium) indologenes, is a non-fermentative gram-negative bacillus which is widely found in the nature, primarily soil and water. Since it can survive in chlorine-treated municipal water supplies, and can colonize the sink basins and tap waters of the hospitals, this bacterium may be a potential infectious agent. Contamination of the medical devices containing water (respirators, intubation tubes, humidifiers, incubators for newborns, etc.) in hospital settings may lead to serious infections especially in patients with predisposing diseases, newborns and immunocompromized patients. In this report, a case of fatal C.indologenes septicemia developed in a newborn with hydrocephalus has been presented. A two-months old male infant was admitted to our hospital with the complaints of failure to suck and lethargy for five days and head enlargement. He was diagnosed as meningitis based on the clinical and laboratory findings of cerebrospinal fluid (CSF) (protein: 572 mg/dl, glucose 9.5 mg/dl, chlorine: 111 mg/dl, and presence of abundant polymorphonuclear leukocytes), and empirical antibiotic treatment (ampicillin/sulbactam and cefotaxime) had been started. Since the computerized tomography of the brain pointed out hydrocephalus, an external shunt was placed for CSF drainage on the second day of hospitalization. A total of five CSF and two blood cultures collected during the hospitalization period were inoculated into pediatric aerobic CSF and blood culture bottles (BacT/ALERT, BioMerieux, France) and incubated for 24-48 hours. The isolated bacteria from all of the cultures were identified as C.indologenes by conventional methods and BD Phoenix (Becton Dickinson, USA) system. Antibiotic susceptibility tests were performed with microdilution method according to CLSI guidelines. The isolate was found susceptible to ciprofloxacin, levofloxacin and trimethoprim/sulfamethoxazole, while it was resistant to amikacin, gentamicin, tobramycin, piperacillin, cefotaxime, ceftazidime, aztreonarn, meropenem, imipenem, tetracycline, and chloramphenicol. The treatment continued with ampicillin/sulbactam and levofloxacin without removing the shunt. However, C.indologenes growth persisted in CSF and blood cultures of the patient. The general condition of the patient deteriorated on the 65. day of the hospitalization and the patient was lost due to cardiopulmonary arrest. Case reports related to isolation of C.indologenes from blood cultures are present in the literature, however, isolation of C.indologenes from central nervous system was reported previously in a single case. In conclusion, C.indologenes should be considered as opportunistic infectious agents especially in the infectious diseases that develop in immunocompromised patients with underlying disease and with foreign device implementation.