A Case of Bacteremia Caused by Raoultella planticola Direct Identification from Blood Culture by Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry.

Background: Raoultella planticola is an uncommon gram-negative organism found in the environment. Patients and Methods: The patient, an 81-year-old female who had undergone total cystectomy and bilateral ureteral stoma surgery, presented to the hospital with a fever. It was determined that Raoultella planticola was responsible for the bacteremia. Results: Rapid identification of bacteria using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) in blood culture samples and appropriate antibacterial treatment was begun and the patient was discharged three days later. Conclusions: This case emphasizes the presence of a rare pathogen as the cause of bacteremia and underscores the importance of utilizing rapid methods for bacterial identification to establish an accurate diagnosis.

Genomic Characterization of a Carbapenem-Resistant Raoultella planticola Strain Co-Harboring blaIMP-4 and blaSHV-12 Genes.

Raoultella planticola is an emerging bacterial pathogen responsible for causing infections in both humans and animals. Unfortunately, sporadic reports of carbapenem-resistant R. planticola (CRRP) have been documented worldwide. Here we first reported the complete genome sequence of a CRRP isolate RP_3045 co-carrying blaIMP-4 and blaSHV-12, recovered from a patient in China, and its genetic relatedness to 82 R. planticola strains deposited in the NCBI GenBank database, sourced from humans, animals, and the environment. Whole-genome sequencing was performed using the Illumina NovaSeq 6000 and Oxford Nanopore MinION platforms. Phylogenetic analysis was also performed and visualized using a single nucleotide polymorphism (SNP)-based strategy. The complete genome of R. planticola strain RP_3045 was determined to be 6,312,961 bp in length, comprising five contigs that included one chromosome and four plasmids. RP_3045 was found to be multidrug-resistant and harbored several antimicrobial resistance genes, including both blaIMP-4 and blaSHV-12 genes located on a single plasmid. The most closely related strain was hkcpe63, recovered from humans in Hong Kong, China, in 2014, with 506 SNP differences. R. planticola strains were distributed globally and exhibited strong associations among isolates obtained from different sectors. This study provides evidence for the potential of R. planticola to disseminate carbapenem resistance across different sectors, highlighting the critical need for active and continuous surveillance of CRRP.

Exploring Raoultella planticola: Implications for Pediatric Health.

The case presentation discusses the clinical evaluation and treatment of a two-year-old female exhibiting symptoms such as dysuria, constipation, and foul-smelling urine. Upon evaluation, the patient was found to be co-infected with Raoultella planticola and Escherichia coli. This co-infection poses unique challenges in diagnosis and treatment, as both pathogens may contribute to the manifestation of symptoms. The initial diagnosis of Raoultella planticola is notable, given its relatively rare occurrence and the potential for misdiagnosis. This case study contributes to our understanding of diagnosing and distinguishing symptoms at various stages of the illness, particularly in cases of co-infection. Following an initial urinalysis and urine culture confirming the presence of both pathogens, a 10-day course of antibiotics was prescribed. Subsequent examinations at Rady Children's Hospital-San Diego included kidney and abdomen imaging to rule out underlying issues. The co-infection underscores the importance of thorough diagnostic procedures and tailored treatment approaches. Additionally, it highlights the need for heightened awareness among healthcare providers regarding emerging pathogens and their potential clinical implications.

Raoultella planticola Pneumonia: A Rare Causative Organism.

We present a case of Raoultella planticola (R. planticola) infection that resulted in community-acquired pneumonia in an immunocompetent patient with an eight-week history of productive cough. This gram-negative bacterium is typically found in the environment and has the potential to infect humans. Raoultella planticola infections in humans have been recorded in several case reports from throughout the world in recent years, usually affecting immunocompromised patients. Although R. planticola is sensitive to most antibiotic groups, recent studies have revealed an increase in the infrequent acquisition of resistance genes in R. planticola, such as carbapenem resistance, making this pathogen a potential emergent threat. Our patient acquired R. planticola pneumonia in the absence of any underlying risk factors, making this the first case in the UK of R. planticola causing community-acquired pneumonia in an immunocompetent person.

Rare Case of Raoultella planticola Infective Endocarditis after Mitral Valve Replacement Surgery.

Infective endocarditis remains a condition associated with high morbidity and mortality, regardless of advances in diagnosis and therapeutics. The etiology, microbiology, and epidemiology of infective endocarditis have changed in the last years, with healthcare-associated infective endocarditis being responsible for a myriad of cases. Raoultella planticola is rarely the cause of infective endocarditis. We present a 72-year-old Caucasian female with a history of mitral valve replacement for rheumatic valve disease two months before the current presentation, without any immunosuppressive pathologies, diagnosed with Raoultella planticola infective endocarditis. Long-drawn antibiotic treatment led to a full recovery with no evidence of recurrence or relapse. This report highlights the importance of a multimodal approach for the diagnosis of bacterial etiology, the importance of selection and duration of an appropriate antibiotic regimen, and the presence of a rare opportunistic bacteria that has proven pathogenicity in a wide range of organ systems, usually in patients with several risk factors.

Analysis of NDM-1 and IMP-8 carbapenemase producing Raoultella planticola clinical isolates.

Object of our study was to analyze the carriage of resistance genes in carbapenem-resistant Raoultella planticola (CRRP) by whole genome sequencing (WGS). Three strains of CRRP (named WF0027, WF3597 and WF3648) were collected for clinical analysis and susceptibility of antimicrobial agents was determined. The WGS of three strains was done by Illumina platform and strain identification was performed by average nucleotide identity, and the antibiotic resistance genes carried by the three strains were detected by ABRicate software. Whole genome data of 46 CRRP strains were downloaded from the National Center for Biotechnology Information (NCBI) database, and the evolutionary tree was constructed by genomic single nucleotide polymorphism together with this study strains. Antimicrobial susceptibility testing revealed that WF3597 and WF3648 were susceptible to tigecycline and colistin, while exhibited resistance to 24 antimicrobial agents. WF0027 was resistant to 18 antimicrobial agents. A total of 25 resistance genes were identified using ABRicate software. WF0027 carried blaIMP-8, whereas WF3597 and WF3648 carried blaNDM-1 carbapenem resistance gene. As predicted by the PlasmidFinder, WF3597 and WF3648 carried one plasmid IncFII(p14)_1_p14, whereas WF0027 carried five plasmids. Evolutionary tree results show all strains are clustered into six groups, the strains WF3597 and WF3648 belonged to the same evolutionary group (E clade) and WF0027 belonged to the F clade. Three CRRP strains in our study carried carbapenem resistance genes (blaNDM-1 or blaIMP-8) and were resistant to multiple antimicrobial agents, posing a significant challenge for clinical treatment.

COVID-19 Bullous Lung Disease Superinfection by Raoultella planticola.

Bullous lung lesions from coronavirus disease 2019 (COVID-19) pneumonia, causing pneumothorax, are a rare complication, affecting up to 1% of infected patients. Raoultella planticola is an aerobic, gram-negative bacteria known to cause opportunistic infection. We present a rare case of spontaneous pneumothorax from rupture of lung bulla as a late sequela from COVID-19 pneumonia and superinfection of the bulla by R. planticola. Although superinfection of bullous lesions is known, this is the first reported case of R. planticola pneumonia in a patient with COVID-19 lung bullae. COVID-19 patients are at heightened risk for bullous lung lesions and superinfection by opportunistic organisms; thus, they should be followed up closely.

First Case of Raoultella planticola Urinary Tract Infection Reported in Western Romania.

Raoultella planticola is a Gram-negative bacterium rarely involved in urinary tract infections. The patient was an 80-year-old woman with several associated diseases who presented to the hospital with fever and dysuria. Raoultella planticola was identified to be the causative agent of the urinary tract infection. Antibacterial treatment led to a full recovery within 7 days. This report highlights the presence of a rare pathogen as a causative agent in the case of a urinary tract infection and also the importance of using multiple methods in order to identify bacteria and to establish the diagnosis.

Draft genome of Raoultella planticola, a high lead resistance bacterium from industrial wastewater.

Isolation of heavy metals-resistant bacteria from their original habitat is a crucial step in bioremediation. Six lead (Pb) resistant bacterial strains were isolated and identified utilizing 16S rRNA to be Enterobacter ludwigii FACU 4, Shigella flexneri FACU, Microbacterium paraoxydans FACU, Klebsiella pneumoniae subsp. pneumonia FACU, Raoultella planticola FACU 3 and Staphylococcus xylosus FACU. It was determined that all these strains had their Minimum inhibitory concentration (MIC) to be 2500 ppm except R. planticola FACU 3 has a higher maximum tolerance concentration (MTC) up to 2700 ppm. We evaluated the survival of all six strains on lead stress, the efficiency of biosorption and lead uptake. It was found that R. planticola FACU 3 is the highest MTC and S. xylosus FACU was the lowest MTC in this evaluation. Therefore, transmission electron microscopy (TEM) confirmed the difference between the morphological responses of these two strains to lead stress. These findings led to explore more about the genome of R. planticola FACU 3 using illumine Miseq technology. Draft genome sequence analysis revealed the genome size of 5,648,460 bp and G + C content 55.8% and identified 5526 CDS, 75 tRNA and 4 rRNA. Sequencing technology facilitated the identification of about 47 genes related to resistance to many heavy metals including lead, arsenic, zinc, mercury, nickel, silver and chromium of R. planticola FACU 3 strain. Moreover, genome sequencing identified plant growth-promoting genes (PGPGs) including indole acetic acid (IAA) production, phosphate solubilization, phenazine production, trehalose metabolism and 4-hydroxybenzoate production genes and a lot of antibiotic-resistant genes.

Raoultella planticola and urinary tract infection: The first laboratory-confirmed case in an HIV-infected patient in Mali.

Raoultella planticola is a Gram-negative, aerobic, non-motile bacterium, abundant in the environment, but rarely associated with pathology in humans. Notably, few urinary tract infections caused by R. planticola have been reported. To our knowledge, we are presenting here the first case of urinary tract infection caused by R. planticola in an HIV-infected individual. It is a 50-year-old female, with a history of HIV-1 infection treated for three years. At admission, her CD4 count was 70 cells/mL, and the main complaints were severe diarrhea and cough. She was diagnosed and treated for pulmonary tuberculosis (TB) and E. Coli enteritis. Initially, we observed a good evolution. However, on day 21 of hospitalization, she presented with fever and dysuria. Urinalysis revealed the presence of R. planticola with resistance to multiple antibiotics. We also detected that she has an HIV-2 but not HIV-1 infection. After receiving the right regimen, she was confirmed cured of her bacterial infections.

Myasthenic Crisis Precipitated by Raoultella Planticola in an Immunocompromised Host.

We present a case of a 39-year-old male patient who was previously diagnosed with myasthenia gravis. He presented in a myasthenic crisis secondary to a lower respiratory tract infection, with the implicated organism being Raoultella planticola. He was referred to the intensive care unit (ICU) and required ventilatory support due to respiratory insufficiency. Early broad-spectrum antibiotics for a suspected bacterial infection were provided in combination with management specific to the myasthenic crisis. The patient made a full recovery and has displayed a good clinical response. This case report explores his presentation and aims to provide further literature on the incidence and description of R. planticola.

Características clínicas y microbiológicas de pacientes con aislamiento por Raoultella spp. en Bogotá, Colombia / Clinical and microbiological characteristics of patients with Raoultella spp. isolation in Bogotá, Colombia

Introducción: Raoultella spp. es un bacilo gramnegativo con importancia clínica creciente por el desarrollo de multirresistencia y porque se ha reportado como causa de infección invasiva. El riesgo de infección aumenta si se presentan comorbilidades como diabetes mellitus y neoplasias.MétodosEstudio descriptivo de las características clínicas y microbiológicas en pacientes adultos con aislamiento de Raoultella spp., atendidos en un hospital de cuarto nivel de Bogotá, Colombia, entre 2015 y 2020.ResultadosSe identificaron 61 pacientes con aislamiento de Raoultella spp., 51 se consideraron infección y 10, colonización. Las comorbilidades asociadas fueron hipertensión arterial (n=26, 42,6%), fallo cardiaco (n=19, 31,1%) y diabetes mellitus (n=18, 29,5%). Se encontraron patrones de resistencia AmpC en 10 muestras (16,4%) y KPC en 3 (4,9%).ConclusionesEs una infección emergente de importancia clínica por su aislamiento en pacientes inmunocomprometidos con múltiples comorbilidades y por el aumento de cepas multirresistentes.

Neumonía por Raoultella planticola en paciente con COVID-19 crítico / Raoultella planticola pneumonia in a patient with critical COVID-19

RESUMEN Raoultella Planticola es una bacteria que se ha descrito recientemente en la literatura como patógeno emergente de infecciones urinarias, abdominales y pulmonares. A continuación, se presenta el caso de un paciente de 63 años con antecedente de sobrepeso y dislipidemia hospitalizado en contexto de neumonía por SARS CoV2 quien presenta sobreinfección por R. Planticola y E. Aerogenes. Recibió manejo con Cefepime por 7 días con adecuada evolución clínica.

ABSTRACT Raoultella planticola is a bacterium that has been recently described in the literature as an emerging pathogen that causes urinary, abdominal, and lung infections. We present the case of a 63-year-old overweight and with dyslipidemia that was hospitalized because of a SARS-CoV-2 infection. He developed R. planticola and E. aerogenes superinfections. He was treated with cefepime for seven days, and he recovered uneventfully.

Clinical and microbiological characteristics of patients with Raoultella spp. isolation in Bogotá, Colombia. / Características clínicas y microbiológicas de pacientes con aislamiento por Raoultella spp. en Bogotá, Colombia.

INTRODUCTION: Raoultella spp. is a gram-negative bacillus with increasing clinical importance due to the development of multi-drug resistance and because it has been reported as a cause of invasive infection. The risk of infection increases if comorbidities present such as diabetes mellitus and malignancies. METHODS: Descriptive study of clinical and microbiological characteristics in adult patients with Raoultella spp. isolation, treated at a fourth-level hospital in Bogotá, Colombia, between 2015 and 2020. RESULTS: 61 patients with isolation of Raoultella spp., 51 were considered infection and 10, colonization. The associated comorbidities were hypertension (n=26, 42.6%), heart failure (n=19, 31.1%) and diabetes mellitus (n=18, 29.5%). AmpC resistance patterns were found in 10 samples (16.4%) and KPC in 3 (4.9%). CONCLUSIONS: Raoultella spp. is of clinical importance due to its isolation in immunocompromised patients with multiple comorbidities and due to the increase in multi-resistant strains.

Synthesis of Silver Nanoparticles by Raoultella Planticola and Their Potential Antibacterial Activity Against Multidrug-Resistant Isolates.

Background: Nanoparticles can be chemically, physically, or biologically synthesized. Biosynthesis of silver nanoparticles (AgNPs) utilizing microbes is a promising process due to the low toxicity and high stability of AgNPs. Here, AgNPs were fabricated by Gram-negative Raoultella planticola. Objectives: This study aimed to assess the ability of Raoultella planticola to produce nanoparticles (NPs) and evaluate their antibacterial potential against multidrug-resistant pathogens (MDR). Additionally, the study aimed to compare the antibacterial activity of biosynthesized nanoparticles to well-known conventional antibiotics Azithromycin and Tetracycline. Materials and Methods: AgNPs were characterized using visual observation, UV-visible spectroscopy (UV-vis), X-ray diffraction (XRD), transmission electron microscopy (TEM), scanning electron microscopy (SEM), and Fourier-transform infrared spectroscopy (FTIR). The TEM and SEM were used to determine the size and shape of the nanoparticles. The XRD data were recorded in the 2θ ranging from 20-80° to analyze the crystalline structure of nanoparticles. The antibacterial activity was detected using a 96-well microtiter plate. Results: The UV-vis absorption recorded from the 300 - 900 nm spectrum was well defined at 420 nm, and the XRD pattern was compatible with Braggs's reflection of the silver nanocrystals. FTIR showed absorbance bands corresponding to different functional groups. TEM and SEM images showed non-uniform spherical and AgNPs of 10-80 nm. XRD data confirmed that the resultant particles are AgNPs. The AgNPs showed effective activity against multi-drug resistant (MDR) Pseudomonas aeruginosa, Salmonella sp., Shigella sp., E. coli, Enterobacter sp., Staphylococcus aureus, and Bacillus cereus. The AgNPs demonstrated effectiveness in lower concentrations compared to broad-spectrum antibiotics. Conclusion: These data reveal that AgNP generated by R. planticola was more efficient against MDR microorganisms than commercial antibiotics. However, the cytotoxicity of these nanoparticles must be further studied.

Bacteriemia por Raoultella planticola: descripción de un caso y revisión de la literatura / Raoultella planticola bacteraemia: a case report and review of the literature

Raoultella planticola (R. planticola) is an anaerobic gram-negative bacillus implicated in urinary, intra-abdominal, skin and soft tissue infections, pneumonia and bacteraemia. We depict here the clinical case of a 74-year-old woman, medicated lifelong with phenytoin, with bacteraemia caused by R. planticola, successfully treated with ceftriaxone. To date, a comprehensive literature review, revealed 52 published clinical cases (between 2007- 2019), thirteen of which due to bacteraemia. (AU)

Raoultella planticola (R. planticola) es un bacilo anaerobio Gram negativo implicado en infecciones de partes blandas, urinarias, intra-abdominales, neumonías y episodios de bacteriemia. Presentamos el caso de una mujer de 74 años, tratada con fenitoína de forma crónica, con bacteriemia por R. planticola tratada de forma exitosa con ceftriaxona. Hasta la fecha, tras realizar una revisión de la literatura, se han descrito 52 casos entre 2007 y 2019, trece de los cuales presentaron bacteriemia. (AU)

A rare pathogen Raoultella planticola caused urinary tract infection in child with congenital anomalies of kidney and urinary tract: case report.

Raoultella planticola was previously considered an environmental organism in soil, water, and plants. However, several cases of human infection have recently been reported in association with R. planticola, some of which have been life-threatening. Most cases were in adults with reduced immunity, with few cases in children. To our knowledge, there have only been two reported cases of urinary tract infection (UTI) caused by R. planticola in children, including one case of cystitis. Here, we present the first case of UTI caused by R. planticola with congenital anomalies of kidney and urinary tract (CAKUT) in a 4-month-old male infant. The patient presented to the emergency department with fever and was diagnosed with UTI. We started third-generation cephalosporins empirically for gram-negative bacteria in the urine, presuming infection with Escherichia coli. On day 1, the patient's fever resolved immediately. On day 2, urine culture was positive for a rare pathogen, R. planticola, and we narrowed antibiotics to first-generation cephalosporins. The patient's fever did not return and he was discharged on day 7. The patient was seen in the clinic 1 week after discharge, with complete resolution of symptoms. Magnetic resonance urography and dynamic renal scintigraphy performed 2 months after discharge revealed severe bilateral hydronephroureter and obstruction of urine flow in the right kidney. As of 6 months after UTI onset, we have continued low-dose cephalexin (10 mg/kg) to prevent the recurrence of UTI and there has been no recurrence. As in this case, children with UTI caused by R. planticola may be associated with CAKUT; therefore, we should actively screen to detect CAKUT. Patients with CAKUT are at high risk of UTI recurrence, so long-term use of unnecessary broad-spectrum antibiotics should be avoided to prevent antimicrobial resistance. However, R. planticola infection is sometimes life-threatening. Hence, it is also important to use sufficiently strong antibiotics for an appropriate period. Although the optimal management of R. planticola infection in children has not been clearly established, we suggest that we can treat UTI caused by R. planticola mainly using first-generation cephalosporins.

Raoultella planticola Infection in Urine.

Raoultella planticola is a gram-negative, aerobic, nonmotile bacteria that can be found in soil and water. This is a relatively rare organism with few case reports on it and only three reports of R. planticola-induced urinary tract infection (UTI) have been reported. Here we present a case of acute cystitis caused by R. planticola in a woman with atrial fibrillation and recurrent UTIs.

Microbiological and Clinical Aspects of Raoultella spp.

The genus Raoultella was established in 2001. Species of Raoultella and Klebsiella share many ecological, biochemical, clinical, and microbiological features. Given the shortcomings of available technology for species identification in the clinical microbiology laboratory, are practically indistinguishable. Since the late 2000s there has been an increase in case reports of human Raoultella infections. Therefore, several authors are postulating that Raoultella spp. are rare and/or emerging pathogens. Conclusions:Raoultella spp. are very similar to Klebsiella spp. The epidemiology and the clinical relevance of the human Raoultella spp. infections is uncertain and further studies are required. The previous difficulties in the identification of Raoultella spp. and the introduction of more precise identification techniques may explain the recent increase in the number of case reports. Raoultella spp. might be rather underdiagnosed than rare or emerging pathogens.

A novel case of Raoultella bacteremia secondary to liver abscess formation following transarterial chemoembolization.

Raoultella planticola is an uncommon gram-negative bacterium that has rarely been identified as the causative organism in severe infections. Few cases have been described and have included patients with pneumonia, urinary tract infections or cholangitis. Only one case has reported to involve a liver abscess, thought to be from a primary urologic source. We describe the case of a 73-year-old man with recently diagnosed hepatocellular carcinoma who developed multiple pyogenic liver abscesses. The abscesses were thought to have developed in the setting of recent transarterial chemoembolization leading to R. planticola bacteremia noted on admission. Treatment with ceftriaxone and metronidazole was initiated in addition to drainage of the abscesses, resulting in decreased size of liver collections and initial clinical improvement. R. planticola remains a rare infectious organism in severe infections affecting both immunocompromised and immunocompetent individuals. Our patient's underlying malignancy and recent transarterial chemoembolization likely placed him at risk of liver abscess formation complicated by bacteremia and sepsis.