Urinary tract infection by a rare pathogen Cedecea neteri in
Cedecea neteri is a gram-negative, oxidase-negative bacillus, a rare pathogen. Few reports are emerging globally about its antimicrobial resistance pattern especially in immunocompromised individuals with comorbidities.

The patient was a 27-year-old pregnant woman at 35 weeks’ gestation who visited the Gynecology outpatient department of RAK hospital with complaints of increased frequency, urgency, and dysuria; classical presentation of UTI. The patient was on follow-up for polyhydramnios. On examination, she was afebrile, well oriented to time, place, and person, with a pulse rate of 86/min, blood pressure of 152/90 mmHg, a known hypertensive.

However, there were no signs of cystitis or pyelonephritis based on abdominal and pelvis ultrasound. Her history revealed that she was multiparous and her first pregnancy ended with twins born by caesarian. During the second pregnancy, she developed polyhydramnios and was on continuous follow-up. Her mid-stream first-morning urine sample macroscopically was cloudy with yellow coloration. Microscopically it showed significant polymorph nuclear cells (18–20 cells/high power field), no RBCs, and 3+ leukocyte esterase activity with plenty of leukocytes and bacteria with less than 1 squamous epithelial cell. Culture and identification yielded significant bacteriuria of 105 CFU/ml of a gram-negative bacterium grown in Cysteine Lactose Electrolyte Deficient (CLED) agar.

On further characterization, the isolate was identified by Phoenix automated microbial identification system, belonging to genus Cedecea and species neteri. To confirm the diagnosis of UTI, two mid-stream urine samples on consecutive days were further cultured. Both samples showed significant growth (105 CFU/ml) of C. neteri and thus confirmed the diagnosis.

Antimicrobial susceptibility testing showed the isolate to be resistant to Amikacin, Aztreonam, Cephalothin, Ceftriaxone, Ertapenem, Cefepime, Cefoxitin and susceptible to Ampicillin, Ampicloxacillin, Nitrofurantoin, Levofloxacin, Tigecycline & Piperacillin/Tazobactum. The patient was treated with one gram of Augmentin (combination of 875 mg amoxicillin and 125 mg clavulanic acid) for 5 days and urine culture was sterile post 1 week of treatment.

Source: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06298-y