Cholangitis with septic shock caused by Raoultella planticola

Abstract

Raoultella planticola (formerly Klebsiella planticola) is a Gram-negative bacterium that has been rarely reported in association with human infection. Here we describe a case of cholangitis complicated with septic shock caused by R. planticola in an immunocompromised patient with advanced cancer who underwent endoscopic retrograde cholangiopancreatography to extract common bile duct stones. The infection was cleared by piperacillin-tazobactam treatment.

Raoultella planticola bacteraemia

“…Similarities of our case to the six summarized by Yokota et al (2012) and the additional four reported by other authors (Castanheira et al, 2009;Kim et al, 2012;Teo et al, 2012) include an association with invasive procedures or trauma (8/11, ERCP in two), an intraabdominal focus (4/11, cholangitis/ cholecystitis in three) and malignancy (3/11). Of the ten previously reported cases of infection due to R. planticola, five involved a monobacterial bacteraemia (Castanheira et al, 2009;Freney et al, 1986;Yokota et al, 2012).…”

“…Of the ten previously reported cases of infection due to R. planticola, five involved a monobacterial bacteraemia (Castanheira et al, 2009;Freney et al, 1986;Yokota et al, 2012). Unique to our case is the involvement of this organism in a polymicrobial bacteraemia in the presence of cholangitis and ERCP.…”

“…The case prompted a comprehensive literature search of English language articles indexed in Medline, Embase and Google Scholar databases. A review article (Yokota et al, 2012) summarizing six cases of human infection due to this organism was retrieved. Our search revealed four additional cases (Castanheira et al, 2009;Kim et al, 2012;Teo et al, 2012).…”

A new emerging oral infection: Raoultella planticola in a boy with haematological malignancy

“…Three patients who developed bacteraemia died, due to multi-drug resistance strains. Various authors suggest at least four possible scenarios that could make a patient develop an infection with this pathogen: (a) inoculation of a significant load of bacteria in a immunologically and/or anatomically injured site, due to trauma in a contaminated environment (community acquired; O'Connell et al 2010;Kim et al 2012); (b) introduction of the pathogen through invasive hospital procedures (nosocomial infection; Freney et al 1984;Kim et al 2012; (c) activation of dormant colonies in immunocompromised patients (Alves et al 2007;Yokota et al 2012) (d) enteric fever and bacteraemia in immunocompetent individuals (fish poisoning; Puerta-Fernandez et al 2013). Extended post-hoc anamnesis did not reveal any recent fish intake (though he had close contact with farm animals) or particular trauma prior to chemotherapy, which makes reactivation of dormant colonies the most probable mechanism in this patient.…”

Bacteremia with Raoultella planticola in the setting of acute pancreatitis complicated with acute cholangitis

“…Fifteen bacteremia cases were found in the literature, of which four included cholangitis. It usually affects people with significant co-morbidities (usually immunosuppressed individuals) related to trauma and/or prior invasive procedures (1)(2)(3)(4). Prognosis is good as the pathogen is sensitive to most antibiotics, although resistance has already been reported (5).…”