Division of Infectious Diseases, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
Department of Microbiology, Tokyo Medical University, 6-1-1 Shinjuku-ku, Shinjuku, Tokyo, 160-8402, Japan.
BMC Infect Dis. 2024 Feb 9;24(1):180. doi: 10.1186/s12879-024-09092-8.
Pseudomonas nitroreducens is a non-fermenting, gram-negative, rod-shaped bacterium commonly inhabiting soil, particularly soil contaminated with oil brine. To our knowledge, no cases of human infection with P. nitroreducens have been previously reported. Here, we present the first documented case of cholangitis caused by P. nitroreducens in a patient with bacteremia.
A 46-year-old Japanese man with an advanced pancreatic neuroendocrine tumor was hospitalized with fever and chills. Four days before admission, the patient developed right upper abdominal pain. Two days later, he also experienced fever and chills. Endoscopic retrograde cholangiopancreatography was performed on the day of admission, and the patient was diagnosed as having cholangitis associated with stent dysfunction. Gram-negative rods were isolated from blood cultures, but attempts to identify the bacteria using VITEK2 and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) with VITEK MS ver. 4.7.1 (bioMérieux Japan Co. Ltd., Tokyo, Japan) were unsuccessful. Finally, the organism was identified as P. nitroreducens using MALDI-TOF MS with a MALDI Biotyper (Bruker Daltonics Co., Ltd., Billerica, MA, USA) and 16 S ribosomal RNA sequencing. Despite thorough interviews with the patient, he denied any exposure to contaminated soil. The patient was treated with intravenous cefepime and oral ciprofloxacin for 16 days based on susceptibility results, achieving a good therapeutic outcome. At the outpatient follow-up on day 28, the patient was in good general condition.
This is the first reported human case of cholangitis with bloodstream infection caused by P. nitroreducens. This report provides clinicians with novel insights into the clinical manifestations and diagnostic methods necessary for the accurate diagnosis of P. nitroreducens, along with guidance on treatment.
铜绿假单胞菌是一种不发酵、革兰氏阴性、杆状细菌，通常栖息于土壤中，特别是受油盐水污染的土壤。据我们所知，以前没有报告过人类感染铜绿假单胞菌的病例。在这里，我们首次报道了一例由血液感染铜绿假单胞菌引起的胆管炎病例。
一名 46 岁的日本男性患有晚期胰腺神经内分泌瘤，因发热和寒战住院。入院前 4 天，患者出现右上腹痛。两天后，他还出现发热和寒战。入院当天进行了经内镜逆行胰胆管造影术，患者被诊断为胆管炎合并支架功能障碍。从血培养中分离出革兰氏阴性杆菌，但使用 VITEK2 和基质辅助激光解吸/电离飞行时间质谱（MALDI-TOF MS）（VITEK MS ver.4.7.1，生物梅里埃日本有限公司，东京，日本）尝试鉴定细菌均未成功。最后，使用 MALDI-TOF MS 结合 MALDI Biotyper（布鲁克·道尔顿公司，马萨诸塞州比勒里卡）和 16S 核糖体 RNA 测序鉴定该菌为铜绿假单胞菌。尽管对患者进行了彻底的访谈，但他否认有接触污染土壤的情况。根据药敏结果，患者接受了 16 天的静脉注射头孢吡肟和口服环丙沙星治疗，取得了良好的治疗效果。在第 28 天的门诊随访时，患者一般情况良好。
这是首例报道的由铜绿假单胞菌引起的胆管炎伴血流感染的人类病例。本报告为临床医生提供了有关铜绿假单胞菌的临床表现和准确诊断所需的诊断方法的新见解，并提供了治疗指导。
