ROSEOMONAS GILARDII-ASSOCIATED BACTEREMIA IN THE SETTING OF COVID-19 PNEUMONIA

TOPIC: Chest Infections TYPE: Fellow Case Reports INTRODUCTION: Roseomonas genus was described in 1993 by Rihs et al. as a "pink coccoid", non-fermentative, aerobic, gram-negative bacteria . It has been isolated from environmental sources (e.g., water, soil, air, and plants); however, human infections are rare. We report a case of R. gilardii associated bacteremia in the setting of COVID-19 pneumonia. CASE PRESENTATION: 73-year-old man with history of HIV (on Bictarvy, well controlled), and diabetes presented with progressive shortness of breath. On admission he was tachypneic, hypoxic, and tachycardic. Lab findings showed lactic acidosis, leukocytosis, respiratory acidosis, elevated inflammatory markers, and COVID-19 PCR positive. He was in acute hypoxic respiratory failure requiring escalation of oxygen therapy with eventual intubation. CT angiography of the chest showed diffuse bilateral subpleural ground glass opacities and lower lobe consolidation with air bronchogram. He was started on Dexamethasone 6mg (10 days), Remdesevir (1 dose), and empiric antibiotics for pneumonia. After 5 days of above therapy patient continued to deteriorate and plasma exchange was given as a salvage therapy. Blood cultures from admission grew Roseomonas Gilardii, which was susceptible to Cefepime. After literature review cefepime was switched to imipenem, cilastatin and amikacin due to studies suggesting high amounts of resistance to Cephalosporins. DISCUSSION: Majority of infection due to R. spp occur in immunocompromised patients (e.g., ESRD, cancer and transplant). These organisms are susceptible to quinolones, carbapenems, and cephalosporins with recommended duration of treatment being 15 days . R. mucosa isolates are resistant to ceftazidime, cefepime, piperacillin, tazobactam, and colistin. R. gilardii is more susceptible than R. mucosa to tested antimicrobial agents. CONCLUSIONS: This is the first reported case of R. gilardii associated empyema in a COVID-19 patient. This underlines the impact of superinfections in COVID-19. R spp. infection in humans is rare and have an inherent resistance to cephalosporins, but high susceptibility to Amikacin and Imipenem. REFERENCE #1: Rihs JD, Brenner DJ, Weaver RE, Steigerwalt AG, Hollis DG, Yu VL. 1993. Roseomonas, a new genus associated with bacteremia and other human infections. J. Clin. Microbiol. 31:3275–3283. REFERENCE #2: Petros Ioannou, Vasiliki Mavrikaki & Diamantis P Kofteridis (2020). Roseomonas species infections in humans: a systematic review, Journal of Chemotherapy, 32:5, 226-236, DOI: 10.1080/1120009X.2020.1785742 REFERENCE #3: Dé I, Rolston KV, Han XY. Clinical significance of Roseomonas species isolated from catheter and blood samples: analysis of 36 cases in patients with cancer. Clin Infect Dis. 2004 Jun 1;38(11):1579-84. doi: 10.1086/420824. Epub 2004 May 7. PMID: 15156446. DISCLOSURES: No relevant relationships by Aneeta Kumari, source=Web Response No relevant relationships by Kunal Nangrani, source=Web Response No relevant relationships by Jose Orsini, source=Web Response No relevant relationships by Evgeny Pinelis, source=Web Response No relevant relationships by Priya Raju, source=Web Response No relevant relationships by Keerthi Reddy Ramireddy, source=Web Response Speaker/Speaker's Bureau relationship with Allergan Please note: $20001 - $100000 by Joshua Rosenberg, source=Web Response, value=Honoraria No relevant relationships by Waqqas Tai, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response No relevant relationships by John Zeibeq, source=Web Response