A 57 year old male with history of benign prostatic hyperplasia status post transurethral resection of the prostate and type 2 diabetes mellitus presented with acute onset of confusion and agitation that began 1 day prior to admission. 1 week ago, he underwent TURP for BPH and urinary retention at an outside hospital; the procedure was uncomplicated, and a temporary foley was placed to be removed within the next 7 days. The patient missed his removal appointment and subsequently developed confusion, agitation, and cloudy urine per wife’s report. He denied fever, chills, or dysuria.
On physical exam, he was tachycardic, hypertensive, and agitated, but afebrile. He exhibited no CVA tenderness, and abdominal exam was benign. Labs were significant for an A1c of 6.1% and cloudy urine showing many bacteria. Subsequent culture grew ampicillin-resistant Raoultella planticola. His condition improved rapidly with ceftriaxone and he was discharged on 10 days of levofloxacin.
This case illustrates a rare bacteria, Raoultella planticola, as a cause of cystitis leading to sepsis following genitourinary tract manipulation in a male. Raoultella planticola is a gram negative rod traditionally thought to be a non-pathogenic, environmental organism with many noted similarities to Klebsiella spp. More recently, it has been identified as a pathogenic organism capable of causing bacteremia, surgical site infection, and multiple organ system infections. While this case was largely antibiotic susceptible, Raoultella shares Klebsiella’s ability to acquire drug resistance through plasmid transmission.
Hospitalists should be aware of Raoultella’s status as a pathogenic organism, not merely an environmental contaminant, and recognize the potential for the development of drug-resistant isolates.