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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 430-431
Urinary tract infection due to Enterobacter sakazakii

Department of Microbiology, Kasturba Medical College, Mangalore - 575 001, India

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Date of Web Publication12-Aug-2009


Enterobacter sakazakii is a rare but important cause of necrotizing enterocolitis, bloodstream infection and central nervous system infections in humans, with mortality rates of 40-80%. It has not been reported to cause urinary tract infection. We report a case of urinary tract infection due to E. sakazakii in a 63-year-old lady with chronic renal failure.

Keywords: Enterobacter sakazakii, renal failure, urinary tract infection

How to cite this article:
Bhat GK, Anandhi R S, Dhanya V C, Shenoy SM. Urinary tract infection due to Enterobacter sakazakii. Indian J Pathol Microbiol 2009;52:430-1

How to cite this URL:
Bhat GK, Anandhi R S, Dhanya V C, Shenoy SM. Urinary tract infection due to Enterobacter sakazakii. Indian J Pathol Microbiol [serial online] 2009 [cited 2021 May 13];52:430-1. Available from: https://www.ijpmonline.org/text.asp?2009/52/3/430/55017

   Introduction Top

Enterobacter sakazakii is a new species in the genus Enterobacter. It was called yellow pigmented E. cloacae until 1980 when it was renamed E. sakazakii . It is considered a ubiquitous bacterium and has been isolated from foods, water and other areas in houses and hospitals. It has been implicated in bloodstream and central nervous system infections with mortality rates of 40-80%. [1],[2] Premature infants are at a greater risk of acquiring E. sakazakii infection. [3] It has been isolated from contaminated powdered milk formula. Other environmental sources are also possible. [4],[5] There is also a strong association between some cases of necrotizing enterocolitis and colonization with E. sakazakii . Contamination of powdered infant formula with E. sakazakii has been linked to devastating neonatal infections. [6] The literature search did not reveal any document of urinary tract infection (UTI) caused by E. sakazakii . We report here a case of UTI due to E. sakazakii in a 63-year-old lady with chronic renal failure.

   Case Report Top

A 63-year-old lady with chronic renal failure and chief complaints of breathlessness was admitted to the Nephrology unit in May 2008. She was a patient with end stage renal damage on maintenance hemodialysis. The patient was on antihypertensives and diuretics. On admission she was afebrile, irritable and conscious. The patient had a respiratory rate of 20/min, pulse rate of 84/min and BP 140/70mm Hg. A urine sample was collected for investigation. It was turbid and revealed 2-3 pus cells/ high-power field and many gram-negative bacilli in gram stain. Urine culture was done using calibrated loop method on blood agar and MacConkey agar. The inoculated plates were incubated at 37ºC for 24 h and examined for bacterial growth. Lactose-fermenting colonies were grown in significant count (>10 5 cfu/ml). The organism was identified as E. sakazakii. Antibiotic susceptibility test was done using Kirby-Bauer disk diffusion method. The isolate was susceptible to amikacin, cefotaxime, co-trimoxazole, gentamicin, netilmicin, nitrofurantion and norfloxacin. Blood culture grew methicillin-resistant Staphylococcus aureus which was susceptible to netilin and vancomycin. Despite treatment, the patient expired six days after hospitalization.

   Discussion Top

The isolate from urine produced smooth yellow-colored colonies, 2-3mm in diameter on blood agar and moist, pink colonies on MacConkey's agar after 24 h incubation at 37°C. The colony count was significant (>10 5 cfu/ml). The bacilli were motile. The isolate was identified using standard methods [7] and antibiotic susceptibility test was performed by disk diffusion method. The gram-negative bacilli were oxidase-negative, fermentative and reduced nitrate. Therefore, the organism was placed under the Enterobacteriaceae family. It fermented glucose, lactose and mannitol with the production of acid and gas but did not ferment sorbitol. It was indole-negative, methyl red-negative, Voges-Proskauer test positive and utilized citrate. It did not decarboxylate lysine and ornithine but was positive for arginine dihydrolase. The organism was thus identified as E. sakazakii . It was susceptible to amikacin, cefotaxime, ciprofloxacin, co-trimoxazole, gentamicin, netilmicin, nitrofurantion and norfloxacin.

E. sakazakii has been reported from invasive infections in infants. [6] It has also been isolated from contaminated powdered infant formula. Premature infants are more susceptible to E. sakazakii infection. [3] The predisposing conditions in adults are not clearly known. Further, to the best of our knowledge, this is the first report of UTI in adults caused by E. sakazakii . Chronic renal failure and old age could have increased the susceptibility of this patient to E. sakazakii infection. The patient may have acquired the bacteria from an environmental source. While the reservoir for E. sakazakii is unknown, many environmental sources have been reported. [1] Susceptibility of the present isolate to antibiotics is also an indication that it may have an environmental source where it is not exposed to antibiotics.

   References Top

1.Bowen AB, Braden CR. Invasive Enterobacter sakazakii disease in infants. Emerg Infect Dis 2006;12:1185-9.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Ray P, Das A, Gautam V, Jain N, Narang A, Sharma M. Enterobacter sakazakii in infants: novel phenomenon in India. Indian J Med Microbiol 2007;25:408-10.  Back to cited text no. 2  [PUBMED]  Medknow Journal
3.Lai KK. Enterobacter sakazakii infections among neonates, children and adults. Medicine 2001;80:113-22.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Simmons BP, Gelfand MS, Haas M, Metts L, Ferguson J. Enterobacter sakazakii infections in neonates associated with intrinsic contamination of a powdered milk formula. Infect Control Hosp Epidemiol 1989;10:398-401.  Back to cited text no. 4  [PUBMED]  
5.Centre for Disease Control and Prevention. Enterobacter sakazakii infections associated with the use of powdered infant formula-Tennessee, 2001. MMWR Morb Mortal Weekly Rep 2002;51:297-300.  Back to cited text no. 5    
6.Jarvis C. Fatal E. Sakazakii infection associated with powdered infant formula in a neonatal intensive care unit in New Zealand. Am J Infect Control 2005;33:e19.  Back to cited text no. 6    
7.Abbott SL. Klebsiella, Enterobacter, Citrobacter, Serratia, Pseudomonas and other Enterobacteriaceae . In: Murray PR, Baron EL, Jorgensen JH, Pfaller MA, Yolken RH, editors. Manual of Clinical Microbiology. 8 th ed. Washington DC: ASM Press; 2003. p. 684-700.  Back to cited text no. 7    

Correspondence Address:
Gopalkrishna K Bhat
Department of Microbiology, Kasturba Medical College, Mangalore - 575 001
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0377-4929.55017

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