Bloodstream infection due to Enterobacter ludwigii , correlating with massive aggregation on the surface of a central ve
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CASE REPORT
Bloodstream infection due to Enterobacter ludwigii, correlating with massive aggregation on the surface of a central venous catheter Lysett Wagner1,2 · Frank Bloos2,3 · Slavena Vylkova1 Received: 26 April 2020 / Accepted: 8 July 2020 © The Author(s) 2020
Abstract We report a case of catheter associated bloodstream infection due to Enterobacter ludwigii with a massive aggregation on the outside surface of a central venous catheter (CVC). The 57 years old patient with a history of spondylodiscitis and Staphylococcus aureus-associated endocarditis was admitted to the intensive care unit for acute cerebral infarction. The patient developed signs of infections and the CVC was removed 11 days after placement. The infectious agent was identified by standard diagnostics to the genus level as belonging to the Enterobacter cloacae complex, and additional molecular testing determined the species as E. ludwigii. The catheter was selected for a study aiming to identify the influence of blood components on the formation of central venous catheter-associated biofilms. In this course a massive biofilm was recognized and is presented here. Keywords Enterobacter cloacae complex · Enterobacter ludwigii · Catheter associated blood stream infection (CABSI) · Sepsis
Introduction Catheter associated bloodstream infections (CABSI) are a common nosocomial infection acquired in intensive care units (ICU). Although CABSI are caused mainly by Grampositive staphylococci and enterococci, infections with Gram-negative bacteria of the family Enterobacteriaceae like Escherichia coli, Klebsiella spp., or Enterobacter spp. are not uncommon [1, 2]. Enterobacter spp. are facultative aero-anaerobic motile bacteria that are constituent of the normal gut microbiota and frequently isolated from human-associated environments. Several species from this genus, such as E. hormaechei and E. cloacae [3], have been associated with * Slavena Vylkova Slavena.Vylkova@leibniz‑hki.de 1
Septomics Research Center, Leibniz Institute for Natural Product Research and Infection Biology – Hans Knöll Institute, Friedrich Schiller University, Albert‑Einstein‑Str. 10, 07745 Jena, Germany
2
Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
3
Department of Anesthesiology and Intensive Care Therapy, University Hospital Jena, Jena, Germany
nosocomial infections in immunocompromised patients. E. cloacae and other closely related species of the Enterobacter cloacae complex (ECC) are known to cause a range of lifethreatening infections, including catheter-associated urinary tract infections and bacteremia [3]. According to the National Nosocomial Infections Surveillance system, 4.9% of the ICU acquired blood stream infections (BSI) were caused by Enterobacter spp. in the US between 1992 and 1999 [4]. Further, the annual epidemiological report “Healthcare-associated infections in intensive care units” for 2017 reports Enterobacter spp. as being responsible for 8.2% of the ICU CABSI cases in Europe [2]. Here we report a
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