From angina to atypical infection: a rare case of pseudomonas oryzihabitans bloodstream infection after percutaneous coronary intervention

Abstract

Pseudomonas oryzihabitans is an infrequent, yellow-pigmented non-fermenting gram-negative bacillus most often linked to device-related infections. We report a rare case of a 73-year-old male with diabetes mellitus, chronic kidney disease and recent non-ST-elevation myocardial infarction (NSTEMI) who underwent three-vessel percutaneous coronary intervention. A left internal jugular central venous catheter was inserted for peri-procedural management. Seventy-two hours later he developed fever (38.3 °C) without localizing signs. Paired peripheral and catheter blood cultures flagged positive after 48 hours. Gram stain showed slender gram-negative rods and empirical antibiotic therapy with piperacillin–tazobactam was started. Subculture yielded non-lactose-fermenting; oxidase-positive colonies identified as Pseudomonas oryzihabitans. Antimicrobial susceptibility testing demonstrated sensitivity only to minocycline; piperacillin/tazobactam and carbapenems were intermediate; amikacin and meropenem resistant. A diagnosis of central-line-associated bloodstream infection (CLABSI) was made and the catheter was removed in accordance with Infectious Diseases Society of America (IDSA) guidelines and intravenous minocycline initiated. The patient became afebrile within 48 hours and completed five days of therapy with full recovery, being discharged on day eight. This case underscores the need to recognize rare non-fermenters as potential CLABSI pathogens in cardiology units, highlights their distinct antimicrobial profile and reinforces guideline-based catheter removal coupled with targeted therapy for optimal outcomes.