Scandinavian Journal of Infectious Diseases

ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19

Association of Raoultella bacteremia with diseases of the biliary tract Kerry O. Cleveland, Shirin A. Mazumder & Michael S. Gelfand To cite this article: Kerry O. Cleveland, Shirin A. Mazumder & Michael S. Gelfand (2014) Association of Raoultella bacteremia with diseases of the biliary tract, Scandinavian Journal of Infectious Diseases, 46:7, 541-542 To link to this article: http://dx.doi.org/10.3109/00365548.2014.896032

Published online: 28 Mar 2014.

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Date: 22 September 2015, At: 11:14

Scandinavian Journal of Infectious Diseases, 2014; 46: 541–542

LETTER TO THE EDITOR

Association of Raoultella bacteremia with diseases of the biliary tract

KERRY O. CLEVELAND, SHIRIN A. MAZUMDER & MICHAEL S. GELFAND

Downloaded by [University of Nebraska, Lincoln] at 11:14 22 September 2015

From the Department of Medicine, Division of Infectious Diseases, University of Tennessee Health Science Center, Memphis, Tennessee, USA

To the Editor, The report by De Jong et al. [1] of several cases of Raoultella bacteremia associated with biliary disease was interesting to us as we recently encountered a similar patient. A 66-y-old woman with unresectable pancreatic cancer was admitted with nausea, emesis, increasing weakness, and neutropenic fever several days after beginning her second cycle of FOLFOX chemotherapy (folinic acid, fluorouracil, and oxaliplatin). There was no history of flushing or recent fish ingestion. Other than a temperature of 39°C, her physical examination (including abdominal examination) was unremarkable. Her absolute neutrophil count was 150 cells/mm3. An abdominal computed tomogram did not reveal abscess or air. Empiric antibiotic therapy with piperacillin–tazobactam 3.375 g intravenously every 6 h was begun. Blood cultures obtained at admission grew Raoultella ornithinolytica and Escherichia coli. Subsequent blood cultures demonstrated clearing of both organisms. Despite this apparent response to treatment of her infection, her condition continued to deteriorate and her family opted for palliative care. She died 18 days after admission. While reviewing materials related to Raoultella spp. we noted many of the same materials referenced by De Jong et al. [1]. Additionally we noted several other reported cases of bacteremia due to Raoultella spp. These are summarized in Table I [2–5]. As described by De Jong et al. [1], many of these cases are associated with biliary disease. Also striking

to us is the possible association with malignant processes that may have involvement of the biliary and/ or pancreatic system. Bile acids have previously been shown to be tumor promoters, and increased ornithine decarboxylase activity has been noted with rapid cell proliferation [6]. The importance of the biliary system and any impact of neoplastic processes on that system and its suitability as a milieu for growth of Raoultella spp. remain to be seen. Declaration of interest: No funding was received for this work. There are no conflicts of interest for the authors to declare.

References [1] De Jong E, Erkens-Hulshof S, Van der Velden LB, Voss A, Bosboom R, Hodiamont SJ, et al. Predominant association of Raoultella bacteremia with diseases of the biliary tract. Scand J Infect Dis 2014;46:141–3. [2] Deeb LS, Bajaj J, Bhargava S, Alcid D, Pichumoni CS. Acute suppuration of the pancreatic duct in a patient with tropical pancreatitis. Case Rep Gastroenterol 2008;2:27–32. [3] Shaikh MM, Morgan M. Sepsis caused by Raoultella terrigena. JRSM Short Rep 2011;2:49. [4] Hadano Y, Tsukahara M, Ito K, Suzuki J, Kawamura I, Kurai H. Raoultella ornithinolytica bacteremia in cancer patients: report of three cases. Intern Med 2012;51:3193–5. [5] Puerta-Fernandez S, Miralles-Linares F, Sanchez-Simonet MV, Bernal-Lopez MR, Gomez-Huelgas R. Raoultella planticola bacteraemia secondary to gastroenteritis. Clin Microbiol Infect 2013;19:E236–7. [6] Tempero M. Bile acids, ornithine decarboxylase, and cell proliferation in colon cancer: a review. Dig Dis 1986;4:49–56.

Correspondence: K. O. Cleveland, 1325 Eastmoreland Avenue, Suite 460, Memphis, TN 38104, USA. Tel: ⫹ 1 901 448 5770. Fax: ⫹ 1 901 448 5940. E-mail: [email protected] (Received 20 December 2013 ; accepted 20 January 2014 ) ISSN 0036-5548 print/ISSN 1651-1980 online © 2014 Informa Healthcare DOI: 10.3109/00365548.2014.896032

Demographics

46-y-old man

69-y-old man 92-y-old man

52-y-old woman 59-y-old man

63-y-old man

66-y-old woman

Ref.

2

3 4

4 4

5

Current report

Gastroenteritis after consumption of “badly cooked” fish Pancreatic cancer

Pancreatic cancer Gastric cancer

Acute suppuration of the pancreatic duct in a patient with chronic pancreatitis Pancreatic cancer Cholangiocarcinoma

Underlying condition

Table I. Summary of additional reported cases of Raoultella bacteremia.

Raoultella ornithinolytica and Escherichia coli

Raoultella planticola

Raoultella ornithinolytica Raoultella ornithinolytica

Raoultella terrigena Raoultella ornithinolytica

Klebsiella ornithinolytica

Organism(s) isolated from blood

Piperacillin–tazobactam

Imipenem–cilastatin followed by cefmetazole Piperacillin–tazobactam followed by cefmetazole Piperacillin–tazobactam followed by cefotaxime

Imipenem followed by piperacillin–tazobactam Piperacillin–tazobactam

Broad-spectrum antibiotics

Antimicrobial treatment

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Improvement followed by transfer to palliative care

Survived

Survived Improvement followed by transfer to palliative care Improvement Improvement

Survived

Outcome

542 K. O. Cleveland et al.

Association of Raoultella bacteremia with diseases of the biliary tract.

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