Catheter-related Blood Stream Infection from a Hickman Catheter Injection Cap by Rhizobium radiobacter

Abstract

A 39-year-old woman was treated for pulmonary hypertension with treprostinil administered via a Hickman catheter. She developed a fever and inflammatory signs at the exit site of the Hickman catheter were observed. On day 2, antimicrobial therapy (ceftriaxone) was started and the Hickman catheter was exchanged. Rhizobium radiobacter was detected from the catheter tip culture. Fever reduction was not observed and her blood culture remained positive despite treatment. We switched antimicrobial therapy from ceftriaxone to tazobactam/piperacillin plus amikacin, but the treatment was not effective. Although enhanced computed tomography scan and transesophageal echocardiography were performed, there were no findings of infectious foci. On day 28, the catheter was exchanged again, but the blood culture on day 29 was still positive. On day 40, we exchanged the catheter again, and this time we exchanged the catheter kit and the injection cap that connected the catheter and drug bag. R. radiobacter was detected from the injection cap. She was afebrile from day 41, and on day 46 her blood culture became negative. Therefore, we diagnosed the problem as catheter related blood stream infection by R. radiobacter, and concluded that the location of infection was the injection cap. Antimicrobial therapy was continued until day 59, and she was subsequently discharged. We experienced a case of catheter related blood stream infection from a Hickman catheter, and it was difficult ―to find the source of infection.