A primal incrimination of Cedecea davisae with post-prostatectomy urinary tract infection in Nigeria

Abstract

Cedecea species are recent members of the family Enterobacteriaceae and are rarely incriminated in human infections. A patient with protracted urinary tract infection, post-prostatectomy, was referred to Lahor Research Laboratories, Benin City, Nigeria for routine culture and susceptibility testing. Three consecutive mid-stream urine samples from him yielded pure, heavy, growths of an apparently same Gram negative, non-spore forming, non-capsulated, motile, rod-shaped bacterium, which was lipase, citrate, methyl red, KCN, ONPG, arginine and ornithine decarboxylase positive. It was oxidase, urease, H₂S, indole, gelatinase, deoxyribonuclease and phenylalanine deaminase negative. It fermented glucose, xylose, sucrose, salicin, maltose mannitol, and lactose but was negative arabinose, inositol, dulcitol, raffinose, rhamnose and melibiose. It exhibited multiple antibiotic resistances to augmentin, gentamicin, ofloxacin, cefixime, ciprofloxacin, ceftazidime and cefuroxime but was very sensitive to imipenem and moderately susceptible to nitrofurantoin. The isolate was identified phylogenetically as Cedecea davisae. It possessed plasmid at 48.5 kb and harboured SHV, TEM, and gyrA antibiotic-resistance genes, which were either plasmid-mediated, chromosomal-mediated or both. To the best of knowledge, this is the first report on the incrimination of this organism with human infection in Nigeria. It was concluded that the paucity of reports on Cedecea species as aetiologic agents of human infections could be as a result of the difficulty in recognizing and characterizing this recently described pathogen, particularly in low resource laboratories, coupled with the fact that Laboratorians and Physicians are yet to be fully aware of the emerging clinical significance of this “relatively new” organism.

Keywords: Cedecea davisae, Difficult-To-Treat, UTI, Nigeria.