Multidrug-Resistant Burkholderia cepacia, Candida dubliniensis, and Candida glabrata Infected Pancreatic Pseudocyst

Abstract

Burkholderia cepacia is a gram-negative bacillus that is most commonly associated with pneumonia in the immunocompromised patients. The most common organisms associated with pancreatic infections are Escherichia coli , Klebsiella pneumoniae , Enterobacter spp . , and Enterococcus spp. We report a case of a 45-year-old gentleman with recent acute pancreatitis who presented with hypoglycemia, altered mental status, worsening epigastric pain, and early satiety. He was diagnosed with a large peripancreatic infected cyst which grew multidrug-resistant (MDR) Burkholderia cepacia , Candida glabrata , and Candida dubliniensis . This case report focuses on the importance of distinguishing and recognizing risk factors for this MDR organism, in order to provide better patient care.

Candida glabrata infection of a pancreatic pseudocyst in a COVID-19 patient: A case report and review of the literature

“…Infectious ailments of pancreatic pseudocysts remain a widely known complication of acute pancreatitis. Medical and surgical literature is replete with studies detailing pancreatic pseudocyst infections, many of which are delineated in Table 1 [ [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] ]. In 2018, Shi et al presented the case of a 26-year-old Chinese woman presenting with severe acute pancreatitis with subsequent hospitalization [ 6 ].…”

“…In another case report, a 45-year-old man was hospitalized for a constellation of symptoms, characterized by early satiety, worsening epigastric pain, hypoglycemia, and altered mental status three weeks after his hospitalization for acute pancreatitis [ 7 ]. He began experiencing these symptoms while at a rehabilitation facility, as his acute pancreatitis episode was presumed secondary to alcohol abuse.…”

“…A day two abdominal computed tomography (CT) scan revealed a mass consistent with a pancreatic pseudocyst, and blood cultures revealed Burkholderia cepacia resistant to amikacin, cefepime, ciprofloxacin, gentamicin and piperacillin-tazobactam and sensitive to ceftazidime, meropenem, and trimethoprim-sulfamethoxazole (TMP-SMX). By day 10 of ceftazidime treatment, the patient continued to experience spiking fevers [ 7 ]. A CT-guided drainage of the pseudocyst with culture revealed multidrug-resistant (MDR) B. cepacia, Candida dubliniensis, and Candida glabrata.…”

“…Finally, four months after his diagnosis, surgical intervention with explorative laparotomy and open cystogastrostomy revealed a pus-filled pseudocyst and necrotic pancreas. This intervention proved definitive, with improvement and infection elimination [ 7 ].…”