Case Presentation: A 26-year-old male with HbSS sickle cell disease and a history of recurrent hospitalizations for vaso-occlusive crises, requiring a right chest port for pain management and IV fluids, presented with sepsis and an acute vaso-occlusive crisis. Initial infectious workup, including chest X-ray, CT of the chest, abdomen, and pelvis, and urinalysis, was unremarkable. Blood cultures were obtained upon admission, and the patient was empirically treated with IV Piperacillin-Tazobactam and Vancomycin. With symptomatic improvement, antibiotics were discontinued after 24 hours. However, on day 2 of hospitalization, admission blood cultures grew Ochrobactrum anthropi, prompting re-initiation of Piperacillin-Tazobactam. Repeat blood cultures also grew Ochrobactrum anthropi. The right chest port was identified as the likely source of infection, requiring surgical removal. A third set of blood cultures was obtained, and a new left internal jugular Chemo-Port was placed for management of recurrent vaso-occlusive episodes. Blood cultures demonstrated no growth, and he was discharged with a 7-day course of oral Levofloxacin to complete 14 days of antibiotics.
Discussion: This case highlights that infections associated with long-term implantable subcutaneous instruments may present with a diverse array of pathogens. In features suggestive of sepsis, clinical suspicion of any persistent foreign body as the nidus of infection should remain high.1 Ochrobactrum anthropi was initially recognized in literature for its broad, non-specific environmental presence (e.g., soil, aquatic environments) but was eventually identified within clinical contexts through foreign body infection (e.g., catheter, indwelling port).2 While recommendations for empiric antibiotics in bacteremia cover common pathogens, continued application increases the ubiquity of relatively uncommon microbes. Additionally, with development of resistance, bacterial subspecies continue to present with complex susceptibilities, requiring a balance of antibiotic stewardship and clinical acumen to tailor regimens to different infections.3 We emphasize the need for urgent removal of any iatrogenic, subcutaneous foreign body from patients with sepsis, as source control is instrumental to resolution of bacteremia. While the strain identified within this patient demonstrated sensitivities to Piperacillin-Tazobactam, this case reinforces the importance of obtaining blood cultures and susceptibility testing early. It also emphasizes the need for a precise, intentional approach to antibiotic stewardship to ensure both effective clinical outcomes and minimization the risk of rare, fastidious bacteria.
Conclusions: While sepsis guidelines prompt urgent broad-spectrum antibiotics to improve survival, additional consideration should be made regarding early nidus removal. Symptomatic improvement is insufficient to ascertain resolution of bacteremia until a clear source of infection has been removed, as in our case. Additionally, it is essential to practice antibiotic stewardship to mitigate the proliferation of unique, resistant bacteria.