Chapter 140. Infections Due to the HACEK Group and Miscellaneous Gram-Negative Bacteria (Part 4) docx

Chapter 140. Infections Due to the HACEK Group
and Miscellaneous Gram-Negative Bacteria
(Part 4)

Chryseobacterium Species (Formerly Flavobacterium)
C. meningosepticum is an important cause of nosocomial infections,
including outbreaks due to contaminated fluids (e.g., disinfectants and aerosolized
antibiotics) and sporadic infections due to indwelling devices, feeding tubes, and
other fluid-associated apparatuses. Patients with nosocomial C. meningosepticum
infection usually have underlying immunosuppression (e.g., related to
malignancy). C. meningosepticum has been reported to cause meningitis
(primarily in neonates), sepsis, endocarditis, bacteremia, soft tissue infections, and
pneumonia. C. indologenes has caused bacteremia, sepsis, and pneumonia,
typically in immunocompromised patients with indwelling devices.
Chryseobacterium Infections: Treatment
Chryseobacteria are often susceptible to fluoroquinolones, TMP-SMX,
imipenem, and third- or fourth-generation cephalosporins, but susceptibility
testing should be performed.
Pasteurella multocida
P. multocida is a bipolar-staining, gram-negative coccobacillus that
colonizes the respiratory and gastrointestinal tracts of domestic animals;
oropharyngeal colonization rates are 70–90% in cats and 50–65% in dogs. P.
multocida can be transmitted to humans through bites or scratches, via the
respiratory tract from contact with contaminated dust or infectious droplets, or via
deposition of the organism on injured skin or mucosal surfaces during licking.
Most human infections affect skin and soft tissue; almost two-thirds of these
infections are caused by cats. Patients at the extremes of age or with serious
underlying disorders (e.g., cirrhosis) are at increased risk for systemic
manifestations, including meningitis, peritonitis, osteomyelitis, endocarditis, and
septic shock, but cases have also occurred in healthy individuals. If inhaled, P.
multocida can cause acute respiratory tract infection, particularly in patients with

underlying sinus and pulmonary disease.
Pasteurella multocida Infections: Treatment
P. multocida is susceptible to penicillin, ampicillin, ampicillin/sulbactam,
second- and third-generation cephalosporins, tetracyclines, and fluoroquinolones.
β-lactamase-producing strains have been reported.
Miscellaneous Organisms
Agrobacterium radiobacter (tumefaciens) has usually been associated with
infection in the presence of medical devices, including intravascular catheter–
related infections, prosthetic-joint and prosthetic-valve infections, and peritonitis
caused by dialysis catheters. Most cases occur in immunocompromised hosts,
especially individuals with malignancy or HIV infection. Strains are usually
susceptible to fluoroquinolones, third-generation cephalosporins, imipenem, TMP-
SMX, and aminoglycosides.
Chromobacterium violaceum, although rarely a human pathogen,
reportedly has been responsible for life-threatening infections with severe sepsis
and metastatic abscesses, particularly in children with defective neutrophil
function (e.g., those with chronic granulomatous disease). C. violaceum is
generally susceptible to ciprofloxacin (500 mg every 12 h PO or 400 mg every 12
h IV), TMP-SMX, and gentamicin.
Plesiomonas shigelloides is a freshwater organism that causes acute
diarrhea (Chap. 122) and occasionally serious extraintestinal disease, most
commonly in immunocompromised hosts. Ochrobactrum anthropi causes
infections related to central venous catheters in compromised hosts; other invasive
infections have been described. Other organisms include Weeksella species;
various CDC groups, such as EF4 and Ve-2; Flavimonas species;
Sphingobacterium species; Protomonas species; Oligella urethralis; and
Shewanella putrefaciens. The reader is advised to consult subspecialty texts and
references for further guidance on these organisms.
Further Readings
Brouqui P, Raoult D: Endocarditis due to rare and fastidious bacteria. Clin

Microbiol Rev 14:177, 2001 [PMID: 11148009]
Chometon S et al: Specific real-
time polymerase chain reaction places
Kingella kingae as the most
common cause of osteoarticular infections in young
children. Pediatr Infect Dis J 26:377, 2007
Elliott TSJ et al: Guidelines for the antibiotic treatment of endocarditis in
adults: Report of the Working Party of the British Society for Antimicrobial
Chemotherapy. J Antimicrob Chemother 54:971, 2004 [PMID: 15546974]
Goldberg MH, Katz J: Infective endocarditis caused by fastidious oro-
pharyngeal HACEK micro-
organisms. J Oral Maxillofac Surg 64:969, 2006
[PMID: 16713816]
Huang ST et al: Clinical characteristics of invasive
Haemophilus
aphrophilus
infections. J Microbiol Immunol Infect 38:271, 2005 [PMID:
16118675]
Jolivet-Gougeon A et al: Antimicrobial treatment of Capnocytophaga
infections. Int J Antimicrob Agents 29:367, 2007
Martino R et al: Bacteremia caused by Capnocytophaga
species in patients
with neutropenia and cancer: Results of a multicenter study. Clin Infect Dis
33:E20, 2001
Paturel L et al: Actinobacillus actinomycetemcomitans
endocarditis. Clin
Microbiol Infect 10:98, 2004 [PMID: 14759235]
Shie SS et al: Characteristics of Achromobacter xylosoxidans
bacteremia in
northern Taiwan. J Microbiol Immunol Infect 38:277, 2005 [PMID: 16118676]

Udaka T et al: Eikenella corrodens
in head and neck infections. J Infect
54:343, 2007
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Das M et al: Infective endocarditis caused by HACEK microorganisms.
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