Extra-abdominal infections caused by Comamonas kerstersii: Case report

Abstract

Rationale: Comamonas kerstersii mainly causes intra-abdominal infections with favorable outcomes due to high antibiotic susceptibility. We report the first case of pneumonia caused by C Kerstersii, which promoted patient death, and a second urinary tract infection by C Kerstersii with extensive drug resistance. Patient concerns: A 46-year-old male (Case 1) with craniocerebral injury underwent emergency decompressive craniectomy, but his condition deteriorated further and presented with discontinuous fever, small moist rales on both lungs, and respiratory failure. Retrospective average nucleotide identity (ANI) analysis of the genomic sequence of the sputum isolate identified it as C Kerstersii 12322-1, antimicrobial susceptibility testing (AST) revealed that it was sensitive to 18 of 21 tested antibiotics. An 82-year-old male (Case 2) with hypertrophic prostate experienced gradual obstruction during urination, and a urine test revealed WBC ++. Retrospective ANI analysis of the urine isolate identified it as C Kerstersii 121606, which was resistant to 18 of 21 tested antibiotics. Diagnoses: Case 1 was diagnosed empirically as pneumonia caused by C Kerstersii strain 12322-1 secondary to craniocerebral injury and confirmed by retrospective ANI analysis; case 2 was diagnosed empirically as urinary infection secondary to prostate hyperplasia caused by C Kerstersii strain 121606 confirmed by the retrospective ANI analysis. Interventions: Case 1 was administered cefoxitin, cefodizime, imipenem-cilastatin sodium, and underwent comprehensive salvage management. Case 2 was administered doxycycline alone. Outcomes: Case 1 died partially because of untimely identification of the responsible bacteria-12322-1. Case 2 was cured even 121606 exhibited an extensive drug resistance feature. Lessons: Except for intra-abdominal infections with good prognosis, we verified that C Kerstersii could also cause extra-abdominal infections, such as the first pneumonia case and urinary infection. It could promote patient death; actual infections were underestimated due to identification difficulties, posing a health threat due to the presence of extensive drug resistance.

Genomic insight into theComamonas kerstersiiisolated from diarrheal patients in Bangladesh

“…C. kerstersii has previously been considered nonpathogenic (Jiang et al, 2018;Liu et al, 2020b;Opota et al, 2014b;Rong et al, 2022;Voitenkova et al, 2018). It is extensively found in soil, plants, and water with the ability to withstand aquatic environment (Farfán-Cano et al 2021;Mandal et al 2022;Rong et al 2022;Wang et al 2024). But since 2013, the species have been found in several clinical samples like abdominal fluid, peritoneal fluid, blood, urine, stool and recently in sputum (Almuzara et al 2013(Almuzara et al , 2017(Almuzara et al , 2018Biswas et al 2014;Opota et al 2014b;Palacio et al 2020;Liu et al 2020a;Farfán-Cano et al 2021;Mandal et al 2022;Wang et al 2024).…”

“…But since 2013, the species have been found in several clinical samples like abdominal fluid, peritoneal fluid, blood, urine, stool and recently in sputum (Almuzara et al 2013(Almuzara et al , 2017(Almuzara et al , 2018Biswas et al 2014;Opota et al 2014b;Palacio et al 2020;Liu et al 2020a;Farfán-Cano et al 2021;Mandal et al 2022;Wang et al 2024). Several cases of intra-abdominal including appendicitis, peritonitis, diverticulosis, and few extra abdominal cases including urinary tract infection, bacteremia and pneumonia have been reported in number of papers (Farfán-Cano et al 2021;Ryan et al 2022;Wang et al 2024). In most cases the infections associated with C. kerstersii were polymicrobial (Farfán-Cano et al 2021;Bennani et al 2022;Ryan et al 2022) Jiang et al (2018) studied C. kerstersii 8943 and concluded in their study that the genome of C. kerstersii is circular with chromosome measuring 3,547,915 base pairs.…”

“…In a recent paper, it reported that the C. kerstersii strain 121606 was resistant to almost all of the β-lactam class of antibiotic indicating that it has a extensive drug resistance phenotype (Wang et al 2024).…”

“…It is extensively found in soil, plants, and water with the ability to withstand aquatic environment (Farfán-Cano et al 2021; Mandal et al 2022; Rong et al 2022; Wang et al 2024). But since 2013, the species have been found in several clinical samples like abdominal fluid, peritoneal fluid, blood, urine, stool and recently in sputum (Almuzara et al 2013, 2017, 2018; Biswas et al 2014; Opota et al 2014b; Palacio et al 2020; Liu et al 2020a; Farfán-Cano et al 2021; Mandal et al 2022; Wang et al 2024). Several cases of intra-abdominal including appendicitis, peritonitis, diverticulosis, and few extra abdominal cases including urinary tract infection, bacteremia and pneumonia have been reported in number of papers (Farfán-Cano et al 2021; Ryan et al 2022; Wang et al 2024).…”

“…Genetic analysis of the strain C. kerstersii 3132976 revealed three β-lactamase genes (CDSs H8N02_05890, H8N02_08740, and H8N02_17110) and among them H8N02_08740 and H8N02_17110 belong to class A and C β-lactamases, respectively (Moser et al 2021). In a recent paper, it reported that the C. kerstersii strain 121606 was resistant to almost all of the β-lactam class of antibiotic indicating that it has a extensive drug resistance phenotype(Wang et al 2024).…”