Urine Trouble


Video Presentation


Case Presentation: A 64 year old Caucasian male presented to his PCP with fever, chills, and night
sweats. The patient recently underwent a urethroplasty of his prostatic urethra, and subsequently
developed a postoperative abscess along the ventral aspect of his penis requiring incision and drainage.
The patient reports that the urethroplasty did not help him and he still needs to self-catheterize daily. His
past medical history is significant for Peyronie’s Disease, anterior urethral stricture, erectile dysfunction,
and recurrent urinary tract infections. He was previously on Sulfamethoxazole-Trimethoprim when
discharged from the hospital. Vitals on the day of the visit are a blood pressure of 140/74mmgHg,
respiratory rate of 18/min, heart rate of 90/min, and an oxygen saturation of 96%. No abnormalities
were noted on physical exam. Initial labs were pertinent for a white blood cell count of 10.4 x 10^3/uL. A
urinalysis revealed trace blood, 2+ leukocyte esterase, 3-4 RBC’s, white blood cells too numerous to
count, and 2+ bacteria. He was diagnosed with a urinary tract infection. Further work-up consisted of a
urine culture that revealed Raoultella Planticola greater than 100,000 colony forming units per mL.

Discussion: There have been a total of 7 cases of Raoultella Planticola infections in the United States and
this being the eighth. R. Planticola was recently classified as a combination of Klebsiella planticola and
Klebsiella trevisanii due to gene sequencing. Immunocompromised patients have contracted various
types of infections that lead to bacteremia. The most common immunocompromised conditions were
diabetic patients, cancer patients, and organ transplant patients. Other risk factors include proton-pump
inhibitor use and chemotherapy. R. planticola is commonly found in the environment in soil, sewage,
water, plants, seafood, and contaminated urodynamic study equipment. Traces have also been found in
human sputum, urine, stool, and as a reservoir in the GI tract. Due to R. planticola’s ability to convert
histidine to histamine via decarboxylation, it may have a role in scombrotoxin fish poisoning. (The
increase in histamine in fish correlates with the level of fish decomposition.) R. planticola’s genome
sequencing reveals that it’s antibiotic resistance genes are in the same area as heavy metal resistance
genes. Other studies have shown that R. planticola in the gut helps detoxify the chemotherapeutic
medication Doxorubicin by inactivating it in anaerobic conditions. Another key finding is R. planticola’s
ability to degrade primary pollutants, pyrene and benzopyrene. Treatment consists of 3rd generation
cephalosporins and tigecycline for severe cases. The concern is discovering how patients are contracting
R. planticola since it is a rare bacteria to contract even though it is found abundantly in the environment.

Conclusion: Although R. planticola infections are rare throughout the world, they seem to be either
increasing in prevalence or becoming significant enough to showcase themselves in the outpatient
setting. This case demonstrates the importance of having the understanding of R. planticola as it can
lead to a severe bacteremia in hospital settings.