Roultella ornithinolytica infection in infancy: a case of febrile urinary tract infection

Abstract

Raoultella ornithinolytica is a Gram-negative, non-motile, encapsulated, aerobic bacillus belonging to the Enterobacteriaceae family. R. ornithinolytica is a not very common, but emergent causal agent of human infection, and its expression of beta-lactamase provides resistance to commonly used antibiotics. The pathogenetic potential of R. ornithinolytica isolates in human disease has become increasingly important. Several cases of hospital-acquired infection, mostly associated with invasive procedures, or in patients with co-morbidity caused by R. ornithinolytica, have been previously reported in the adult population. In pediatric population, two cases in immunocompromised children, one case in an infant with visceral heterotaxy and one case of catheter-related bacteraemia are described. Here, we present the first case of febrile urinary tract infection due to R. ornithinolytica in an 8-month-old infant, recovered from a previous febrile UTI caused by E. coli and without co-morbidity. The empiric therapy with ceftriaxone, followed by cefpodoxime proxetil, resolved symptoms: the clinical condition of the infant improved rapidly and the treatment eradicated urine from the R. ornithinolytica infection. Since other pathogens rather than R. ornithinolytica are usually identified in children with urinary tract infections, including Escherichia coli, Proteus, Klebsiella and Pseudomonas, the identification of this microorganism in our patient's urine was also unexpected.

Raoultella ornithinolytica Infection in the Pediatric Population: A Retrospective Study

“…As shown in Table 1 , out of the 14 cases of children infected with R. ornithinolytica , eight cases were female and six were male; the oldest child was 16 years old and the youngest was a 18 h newborn. The geographical distribution included one case in the United States ( 15 ), two cases in Japan ( 16 ), one case in Poland ( 17 ), one case in India ( 19 ), one case in South Africa ( 20 ), one case in Italy ( 22 ), two cases in Turkey ( 18 , 21 ), and five cases in China (our report). About half of the children infected with the bacteria were over 3 years old and adolescents (42.8%, 6/14).…”

“…There were two cases of abnormal immune function in our hospital and one case reported in the literatures ( 16 ). Infants and children under 3 years old are more likely to have congenital malformations [two cases in our hospital, and four cases in the literature reports ( 15 , 18 , 20 , 22 )]. Adults are more likely to have urinary tract infections; possibly because urinary catheters are more commonly used in adult patients.…”

“…Raoultella ornithinolytica was previously considered to be a rare opportunistic pathogen, which has not attracted enough attention from pediatricians. Currently, there are only few reports on children infected with R. ornithinolytica all over the world (15)(16)(17)(18)(19)(20)(21)(22), and none of the articles have ever provided a summary of the clinical characteristics of children infected with R. ornithinolytica. In our study, we reported five cases from an 1800-bed teaching hospital in southwest China, which is the largest number of children identified with R. ornithinolytica to date.…”

“…The study was conducted by searching the abroad databases (Pubmed database and Web of Science) and domestic databases (China zhiwang, Weipu database, and Wanfang database) with the key word "Raoultella ornithinolytica," and June 1, 2019 was set as the cut-off date. A total of 25 related reports with eight references to nine pediatric cases were found (15)(16)(17)(18)(19)(20)(21)(22). These nine cases were combined with the five cases from our hospital; the clinical features and identification methods were summarized in Tables 1, 2.…”

Draft Genome Sequence of Raoultella ornithinolytica P079F W, Isolated from the Feces of a Preterm Infant

“…While its genomic diversity and prevalence in the preterm neonate gut microbiota are poorly understood, R. ornithinolytica has been associated with bacteremia, urinary tract infection, and early-onset sepsis in infants (2–4).…”