Rapid severe sepsis from Pseudomonas fluorescens/putida bacteremia due to skin and soft tissue infection – A case report

INTRODUCTION: Pseudomonas fluorescens (P. fluorescens) and Pseudomonas putida (P. putida) are uncommon causes of skin and soft tissue infections (SSTIs). They are rarely associated with bacteremia and fatality. When presenting with sepsis/shock, patients are usually immunocompromised. Our case highlights the importance of early recognition, source control and antimicrobial choice. CASE PRESENTATION: We present a case of an immunocompetent 57 year old female who presented with rapidly progressive septic shock in the setting of P. fluorescens/putida bacteremia. The patient continued to deteriorate despite empiric antimicrobial coverage and aggressive source control. CLINICAL DISCUSSION: P. putida and P. fluorescens are gram negative bacillus bacteria that are ubiquitous in soil and water however have been reported as an opportunistic human pathogen capable of causing nosocomial infection especially in immunocompromised patients. Patients with bacteremia and shock should initially be covered with broad antimicrobial coverage for gram positive, gram negative as well as gas producing organisms and deescalate based on cultures and sensitivities. Along with antibiotics, aggressive source control is found to be the key to successful treatment in these patients. CONCLUSION: Our case highlights an immunocompetent patient with rapid progressive sepsis and associated multisystem organ failure. We emphasize the importance of early recognition in these patients and treatment with appropriate antimicrobial therapy followed by source control.