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A case of Robinsoniella peoriensis bacteremia during using piperacillin-tazobactam
Kento Furuya1, Kenta Ito1, Kyohei Sugiyama2
1Department of Clinical Laboratory Medicine, Shizuoka General Hospital, 4-27-1, Kitaandou, Aoi-ku, Shizuoka, 420-8527, Japan.
Abstract:
Infections caused by Robinsoniella peoriensis, particularly bacteremia, are rare, of which only six cases were reported R. peoriensis bloodstream infections. This case report describes an instance of R. peoriensis bacteremia arising while we treated the patient with piperacillin-tazobactam. We treated an 84-year-old female patient with peritoneal carcinoma and febrile neutropenia using piperacillin-tazobactam. The patient's fever subsided. However, she developed a fever again on the fourth day of treatment with piperacillin-tazobactam. Blood cultures taken at this time were positive for R. peoriensis. We substituted meropenem and vancomycin for piperacillin-tazobactam, after which the patient improved. We administered meropenem and vancomycin for 17 days. There is currently no appropriate established treatment for R. peoriensis. In this case, we isolated R. peoriensis from blood cultures using piperacillin-tazobactam, although it was susceptible to piperacillin-tazobactam in vitro. Therefore, monotherapy with penicillins, especially piperacillin-tazobactam, may not be sufficient for R. peoriensis infections, although it was susceptible in vitro. Carbapenem may be effective in the treatment of R. peoriensis bloodstream infections.
Insights
Rare Robinsoniella peoriensis bacteremia occurred during piperacillin-tazobactam treatment. This suggests carbapenem therapy may be more effective for these infections, even with in vitro susceptibility to penicillins.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Bacteriology
Background:
- Robinsoniella peoriensis bloodstream infections are exceptionally rare, with limited documented cases.
- Effective treatment strategies for R. peoriensis infections remain undefined.
- Piperacillin-tazobactam is a commonly used antibiotic for broad-spectrum coverage.
Observation:
- An 84-year-old female with peritoneal carcinoma and febrile neutropenia was treated with piperacillin-tazobactam.
- Despite initial fever resolution, the patient experienced recurrent fever during piperacillin-tazobactam therapy.
- Blood cultures subsequently identified Robinsoniella peoriensis bacteremia.
Findings:
- The isolated R. peoriensis strain demonstrated in vitro susceptibility to piperacillin-tazobactam.
- Treatment was switched to meropenem and vancomycin, leading to patient improvement.
- This case highlights potential treatment failure of piperacillin-tazobactam for R. peoriensis bacteremia.
Implications:
- Piperacillin-tazobactam monotherapy may be insufficient for treating R. peoriensis infections, irrespective of in vitro susceptibility.
- Carbapenem-based regimens, such as meropenem, show promise for R. peoriensis bloodstream infections.
- Further research is needed to establish optimal therapeutic guidelines for R. peoriensis infections.
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