Wound infection with multidrug-resistant Providencia rettgeri: About a case report and littérature review

Abstract

Introduction and importance

Providencia rettgeri, a member of the Morganellaceae family within the Enterobacterales order, is predominantly associated with urinary tract infections in hospitalized individuals, particularly those with indwelling urinary catheters. However, wound infections caused by P. rettgeri are exceedingly rare, with an estimated incidence of around 0.1 %. Here, we present a case of wound infection in a healthy child caused by P. rettgeri, highlighting the rarity of the organism and emphasizing the importance of prompte identification and appropriate antibiotic therapy.

Case report

A 4-year-old child presented with a soft tissue abscess in the left calf, following an injury sustained from a tree trunk a few days prior. The patient underwent wound debridement and abscess drainage, followed by empirical antibiotic therapy with amoxicillin and clavulanic acid. Bacteriological samples collected intraoperatively revealed colonies of P. rettgeri, identified with high certainty using the BD Phoenix™ 100 automated system. Antimicrobial susceptibility testing showed resistance to several antibiotics but sensitivity to third-generation cephalosporins, amikacin, and aztreonam. Antibiotic therapy was adjusted accordingly, leading to clinical improvement and discharge after ten days of hospitalization

Discussion

P. rettgeri, a Gram-negative bacillus, is a rare causative agent of wound infections. While predominantly associated with nosocomial urinary tract infections, it can rarely lead to various other infections, including wound infections, particularly in hospitalized or immunocompromised individuals. Resistance to multiple antibiotics, including carbapenems, poses challenges in treatment selection.

Conclusion

This case underscores the importance of considering P. rettgeri as a potential pathogen in wound infections, even in healthy individuals. Awareness of its presence and antibiotic susceptibility patterns is crucial for appropriate management and prevention of complications. Further studies are warranted to elucidate the epidemiology and clinical significance of P. rettgeri infections in different patient populations.