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.