Pseudomonas pickettii pneumonia in a diabetic patient

Pseudomonas pickettii is a nonfermenting gram negative rod closely related to Pseudomonas aeruginosa that rarely causes human disease. We describe a case of P pickettii pneumonia in a 41-year-old diabetic patient. Two months prior to admission, patient was treated for a methicillin resistant Staphylococcus aureus pneumonia. Present illness started 2 days prior to admission with fever, chills, pleuritic chest pain, and productive cough. Chest x-ray showed a right lower lobe infiltrate with effusion. Thoracocentesis of the right chest brought a transudative fluid. P picketii was isolated from pleural fluid and blood. The patient was initially treated with aztreonam and piperacillin and therapy was changed to ampicillin according to sensitivity results. The pneumonia resolved after 10 days of antibiotic therapy. Our case is the first reported case of P pickettii pneumonia. P pickettii has been reported to cause nosocomial bacteremias associated with contaminated intravenous products and airway colonization from contaminated respiratory therapy solution. Our patient most likely had oropharyngeal colonization with P pickettii during his previous hospitalization. His underlying illnesses might have predisposed him to aspiration and development of P pickettii pneumonia. This case emphasizes the central role of the microbiology laboratory in the proper identification and sensitivity reporting in the management of respiratory infections caused by unusual organisms, such as P pickettii.