Raoultella Infection Causing Fever of Unknown Origin

Emerging role of Raoultella ornithinolytica in human infections: a series of cases and review of the literature

“…As well as the well-known clinical presentations of R. ornithinolytica infections, such as primary or cholangitis bloodstream infection, [3][4][5]7,14,16,18,20,22 catheter-related bloodstream infection, 8,26 biliary tract infection, 3-5 urinary tract infection, 5,15,21 and skin infection, 19,20 cases of respiratory infection including community-and hospital-acquired pneumonia and pleural effusion were also identified in this study, and these have been poorly reported. Boattini et al recently reported three cases of community-acquired pneumonia and three cases of hospital-acquired pneumonia among 25 cases of R. ornithinolytica infection over a 5-year period in six university hospital centres in Lisbon.…”

“…This series of human infections caused by R. ornithinolytica managed at four university hospital centres in France over the last 12 years is the largest reported to date. A literature search identified 86 reported cases of R. ornithinolytica (formerly Klebsiella ornithinolytica), [3][4][5][6][7][8][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and half of these cases were reported in 2015. 10,12,[24][25][26] A high rate of hospital-acquired infection was observed in the present study (49%), which may be explained by the high proportion of patients who had undergone invasive procedures (48%) involving, for example, urinary catheters, mechanical ventilation, and port catheters.…”

“…21 Among the 86 isolates reported in the literature, 80% were resistant to amoxicillin, 17% to amoxicillin-clavulanic acid, 10% to third-generation cephalosporins, 12% to quinolones, 13% to co-trimoxazole, 15% to piperacillin-tazobactam, 7% to aminosides, and 7% to carbapenems. [3][4][5][6][7][8][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Few of these studies reported cases of R. ornithinolytica infection with isolates resistant to multiple antibiotics, including KPC 14 and NDM-1 strains. 27 In this study, the proportions of isolates resistant to ceftriaxone, quinolones, and aminosides were a little bit lower than reported in the literature (4%, 6%, and 1%, respectively).…”

“…Among the 69 reported cases, the mortality rate of human infections caused by R. ornithinolytica was relatively high (20%). [3][4][5][6]8,[14][15][16][17][18][19][20][22][23][24][25][26] This rate was particularly high in cases of bacteraemia (34-44%). 4,8,14,22,23,25,28 In the study cases, the mortality rate was lower (9%) and included three patients (3%) who died of cancer and six patients (6%) who died of septic shock related to pneumonia (three cases), pleural effusion (one case), skin infection (one case), and cholangitis (one case).…”

<p><em>Raoultella ornithinolytica</em>: Emergence and Resistance</p>

“…1 Sener et al (2011) published a case of fever of unknown origin in a 16-month-old female patient presenting as fever and persistent cough, in whom R. ornithinolytica was identified in bronchoalveolar lavage fluid. 13 Previous detailed cases depict patients with postoperative infections or admitted to the intensive care unit (ICU) with severe systemic alterations. The presence of respiratory infections with R. ornithinolytica in the community seems to be extremely uncommon especially in healthy immunocompetent individuals.…”