Enterobacter sakazakii bacteraemia with multiple splenic abscesses in a 75-year-old woman: a case report
SIR—We read with interest the report of Enterobacter sakazakii bacteraemia in a 75-year-old woman, who presented with tachypnoeia, a left-sided pleural effusion and splenic abscess [1]. We previously reported the identification of E. sakazakii in the mouths of 7 of 203 acute stroke patients []. In four of our seven patients, an abnormal swallow was present on admission and two of these patients subsequently developed a pneumonia on day six and fourteen post stroke, respectively.The two patients with an abnormal swallow and E. sakazakii in the oral cavity who did not develop pneumonia had been treated with SDD gel containing amphotericin, tobramycin and polymixin E as part of a randomised controlled trial, while studying the role of selective decontamination of the oral cavity, post stroke.
In the remaining three patients who had a normal swallow, but in whom E. sakazakii was found in the oral cavity, two received active SDD gel and one placebo, with no evidence of a pneumonic process or septicaemia. In the report of See and colleagues [1], the bacterium was resistant to cephalexin. In our 10 oral isolates, all except one was resistant to ampicillin, one was resistant to tobramycin, three to colistin, four to cephotaxime, four to trimethopin and three to ciprofloxacin. In the case report, the 75-year-old woman deteriorated after an initial clinical response, with the authors surmising that the organism had developed cephalosporin resistance. In one of our patients, in whom E. sakazakii was isolated on four separate occasions, we found that the antibiotic sensitivities altered, probably as a result of the SDD gel.
We would like to speculate that the patient may have had oral colonisation with E. sakazakii, which subsequently resulted in a pneumonia complicated by a splenic abscess. We agree with the authors that E. sakazakii should not be treated with a cephalosporin and that E. sakazakii must be considered in older individuals who fail to respond to traditional antibiotic administration.
We hope that, by highlighting a possible pathogenesis of the E. sakazakii splenic abscess, clinicians caring for older individuals with impaired oral hygiene and abnormal swallow or immunosuppression due to age, disease or treatment, will consider E. sakazakii as an aetiological agent if early treatment fails to result in a clinical response.
Institute of Health Sciences, University of Reading, Building 22, 1st Floor, London Road, Reading, Berkshire, RG1 5AQ, UK
Email: j.farwell{at}reading.ac.uk
References
- See KC, Than HA, Tang T. Enterobacter sakazakii bacteraemia with multiple splenic abscesses in a 75-year-old woman: a case report. Age Ageing (2007) 36:595–6.
[Abstract/Free Full Text] - Gosney MA, Martin MV, Wright AE, et al. Enterobacter sakazakii in the mouths of stroke patients and its association with aspiration pneumonia. Eur J Intern Med (2006) 17:185–8.[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||