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Background/aim: The aim of this study is to evaluate the distribution, sources, clinical features, and mortality rates of bacteremia due to evaluation of extensively drug-resistant (XDR) gram negative among solid-organ transplant (SOT) recipients. Materials and methods:A retrospective study of SOT recipients with bacteremia due to XDR gram-negative pathogens in 11 centers between 2016 and 2018 was conducted. Patients' records were evaluated.Results: Of 171 bacteremia that occurred in 164 SOT recipients, 93 (56.7%) were liver, 46 (28%) kidney, 14 (8.5%) heart, and 11 (6.7%) lung recipients. Bacteremia episodes were recorded in the first year in 63.7% of the patients (n = 109), early-onset bacteremia was recorded in 45% (n = 77) of the episodes. In multivariate analysis, catheter-associated bacteremia was an independent risk factor for 7-day mortality (p = 0.037), and early-onset bacteremia was found as an independent risk factor for 30-day mortality (p = 0.017). Conclusion:Difficult-to-treat infections due to XDR bacteria in SOT recipients shadow the success of transplantation. Central venous catheters seem to be the main risk factor. Judicious use of medical devices is of pivotal importance.

The genus of Cedecea was first isolated by the Centers for Disease Control (CDC) Laboratories in 1981 and designated as a separate genus in the Enterobacteriaceae family. They are Gram negative, lipase positive, non spore forming bacilli. This report presents the first case of urinary tract infection caused by Cedecea lapagei and a brief review of the literature including the reported infections that were caused by Cedecea spp. Forty years old male patient who had an operation for stabilization in brain surgery clinic after spinal cord injury and transferred to physical therapy clinic for rehabilitation, had a temperature of 38.5 o C on the 17th day of the injury and the following results were detected in laboratory examination: WBC 18900/mm³, CRP 345 mg/l and erythrocyte sedimentation rate 38 mm/h, abundant leukocytes and bacteria in urine examination. With the diagnosis of urinary tract infection, the patient was taken over to Infectious Diseases and Clinical Microbiology Clinic. In two consecutive urine cultures 100,000 CFU/ml Gram negative bacilli was isolated and identified as Cedecea lapagei with Phoenix automated system (BD Diagnostics, Sparcs, MD). Following the treatment with ciprofloxacin, his fever decreased on the second day and control urine culture was sterile. Nevertheless, the infections due to Cedecea spp. have been reported in the literature, this was the first urinary tract infection caused by Cedecea lapagei. Rare causes of urinary tract infection like Cedecea spp. should also be taken into consideration in long-term hospitalized patients.

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