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Microbes & Immunity Cedecea lapagei in a case of pleural empyema

Daltonik GmbH, Bremen, Germany) and Vitek™ 2 GN Cedecea superinfection in a 50-year-old Indian man with
system (bioMerieux, Marcy l’Etoile, France), MicroScan a malignant oral ulcer with squamous cell carcinoma of
WalkAway 96 plus System (Beckman Coulter, USA), and the right buccal mucosa. In addition, Islam et al., Ahmed
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VersaTREK blood and body fluid culture system (TREK et al. and Ramaswamy et al. have reported neonatal
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diagnostic, Cleveland, Ohio). 4 cases of Cedecea infection from India.
Cedecea was first recognized as a human pathogen in Cedecea is intrinsically resistant to colistin
2006 by Davis et al. who reported the first case of the (polymyxin E). Data on the Cedecea resistance to drugs
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microorganism in a patient having peritonitis related to remains limited in the literature. It is important to note that,
continuous ambulatory peritoneal dialysis. In this case, according to all of the previous studies, this microorganism
reported by Davis et al., the patient first received a separate showed signs of multidrug resistance (Table 2). Combined
treatment of vancomycin and gentamicin, followed by with the literature review, the current case report establishes
gentamicin and ceftazidime. In 2008, Dalamaga et al. this organism as extensively drug-resistant.
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reported another case of C. lapagei, with a sample
obtained from an infected wound of a patient suffering C. lapagei is an emerging multidrug-resistant pathogen
from cement-related chemical burns. In this case, the in India, presenting a huge treatment challenge. The ever-
patient recovered after treatment. Another case study in increasing complexity of its resistance pattern adds further
the same year was reported by Yetkin et al. in a patient difficulty to the treatment efforts. It is worthy to note that
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with chronic obstructive pulmonary disease (COPD), C. lapagei infection is mainly acquired from the hospital,
but the patient expired. Lopez et al. and Hong et al. similar to our case. Hence, proper infection control
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also described C. lapagei-related pneumonia in 2013 practices and early management of this rare microorganism
and 2015, respectively. In 2015, Biswa et al. reported a should be implemented to improve patient outcome.
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Table 2. Antimicrobial resistance pattern of Cedecea in different studies
Antibiotics Hong Dalamaga Lopez Islam Ahmed Chavez Herrera Ramaswamy Mohamed Xu Current
et al. 8 et al. 5 et al. 7 et al. 10 et al. 11 et al. 2 et al. 13 et al. 12 et al. 16 report
Ampicillin/sulbactam - - I I (16/18) I (16) R (≥32)
Amikacin - S (8) R S (≤4) R S I (≤2) R (≥64)
Ampicillin - - R R (>16) R -
Aztreonam - S (≤2) R R S (≤8) S (≤1)
Ceftriaxone - - R R R S (≤8) R S (≤1) R (≥64)
Ceftazidime S S (≤1) R S (≤1) R R - R (≥64)
Cefazolin - - R R (≥16) R R (≥64)
Cefotaxime S S (≤2) R S (≤2) S (4) R (≥64)
Ciprofloxacin S S (≤0.25) R S S (≤1) S S I (2) R (≥4)
Cefepime S S (≤2) R R S (≤2) S (≤1) R (≥32)
Cefuroxime - - R S(≤4) - R (≥32)
Cefotetan - - S (≤16) -
Gentamicin - R (>8) I R S (2) R I (8) R (≥16)
Imipenem - - R S R R (≥8) S R (4) R (≥16)
Levofloxacin - S (≤1) S (≤2) S S I (2) R (≥8)
Meropenem - S (4) R R S (≤4) R - R (≥16)
Moxifloxacin - - R S (≤2) -
Piperacillin/tazobactam - - R R S (≤8) S S (≤4) R (≥128)
Tobramycin - R (>8) I - I (8)
Cotrimoxazole S - - R - S S R (≥320) R (≥320)
Tigecycline - - S - -
Minocycline S (≤1)
Notes: I: Intermediate; R: Resistant; S: Sensitive values in parentheses indicate the minimum inhibitory concentration (MIC) µg/mL.

Volume 1 Issue 2 (2024) 103 doi: 10.36922/mi.4520