Cedecea lapagei an Extremely Rare Uropathogen: A Case Report

Abstract

Background: Centers for Disease Control (CDC) Laboratories discovered Cedecea lapagei in 1977, and the first case of Cedecea lapagei in humans was reported in 2006. A literature search revealed only one case report of prior isolation of Cedecea lapagei from urine culture, and this is the second case of Cedecea lapagei as an uropathogen reported in the world. Case presentation: A 55 years old man with chronic renal failure, poorly controlled Diabetes mellitus, and Hypertension presented with acute exacerbations of renal failure and irritative voiding symptoms. After stabilization and empirical antibiotic therapy with Ceftriaxone, the patient’s condition was not improved and deteriorated progressively. After the request of urine culture, the culture was isolated, an extremely rare uropathogen; the Cedecea lapagei. Cedecea lapagei identification has been done using Eosin Methylene Blue agar (EMB). Gram-negative lipase positive bacteria with bacillus in shape, motile in nature that is non-spore-forming, and non-encapsulated Enterobacteria with the final result of >100,000 colony-forming units per ml of Cedecea lapagei were isolated. Mueller-Hinton agar had been used to perform antimicrobial sensitivity and resistance. The pathogen revealed antimicrobial resistance against Ceftriaxone, Cephazolin, Ceftazidime, Cefixime, Ampicillin, and Amoxicillin-Clavulanic Acid while Carbapenems, Fluoroquinolones, Aminoglycosides, and Trimethoprim-Sulfamethoxazole showed a higher sensitivity rate. Conclusion: This is the second case of Cedecea lapagei as an uropathogen reported in the world. Cedecea lapagei is a rare bacterial infection in humans and has an emerging antimicrobial resistance. Antimicrobial treatment should be aligned with the culture findings once available.