Volume 31, Number 4—April 2025
Synopsis
Alistipes Bacteremia in Older Patients with Digestive and Cancer Comorbidities, Japan, 2016–2023
, Tomohisa Watari, Naoto Hosokawa, and Yoshihito Otsuka
Table 2
Patient characteristics and clinical course of Alistipes bacteremia in a tertiary care center, Japan, 2016–2023*
| Case ID | Age, y/sex | Comorbid conditions | Clinical symptoms | Clinical diagnosis | Therapy† | Outcome (time) |
|---|---|---|---|---|---|---|
| 1 |
80s/F |
Hypertension, diabetes mellitus, lipid disorder, cerebral infarction history, rectal cancer |
Abdominal pain, septic shock |
Colon perforation, colonic obstruction |
TZP and vancomycin (1 d) |
Death (1 d) |
| 2 |
50s/M |
None |
Abdominal pain |
Acute appendicitis |
SAM (3 d), AMC (11 d), appendectomy |
Alive, discharged (6 d) |
| 3 |
50s/F |
Ovarian cancer, febrile neutropenia |
Abdominal pain, fever |
Perforated colon |
SAM (24 d), TZP (12 d) |
Alive, discharged (50 d) |
| 4 |
90s/F |
Alzheimer’s-type dementia, Hypertension, epilepsy, chronic constipation |
Abdominal pain, vomiting, diarrhea, fever |
Acute appendicitis, secondary peritonitis, paralytic ileus, aspiration pneumonia |
SAM (23 d), AMC (5 d) |
Alive, discharged (22 d) |
| 5 |
60s/F |
Diabetes mellitus, colon cancer |
Abdominal pain, septic shock |
Generalized peritonitis, intestinal perforation, Nonocclusive mesenteric ischemia, ovarian necrosis |
TZP (2 d), cefmetazole (17 d), colectomy, small bowel resection, bilateral salpingo-oophorectomy |
Alive, transferred (114 d) |
| 6 |
70s/M |
Febrile neutropenia, previous hepatitis B virus infection, hypertension, diabetes mellitus, benign prostatic hyperplasia, acute myeloid leukemia |
Fever, abdominal pain |
Colonic diverticulitis |
Cefepime and MTZ (10 d), SAM and MTZ (3 d) |
Alive, discharged (228 d) |
| 7 |
30s/M |
Epilepsy, under treatment for CRBSI with Staphylococcus aureus |
Fever |
Bacteremia of unknown origin |
Cefazolin (5 d), SAM (12 d) |
Alive, transferred (41 d) |
| 8 |
70s/M |
Oral candida, adenocarcinoma (primary site unknown) |
Septic shock, ascites, abdominal distension‡ |
Bowel obstruction |
TZP (1 d), TZP and fluconazole (1 d) |
Death (1 d) |
| 9 |
60s/F |
Rectal cancer |
Abdominal pain, vomiting |
Colon perforation, peritonitis |
TZP (1 d), SAM (14 d), Hartmann’s procedure |
Alive, discharged (28 d) |
| 10 |
90s/F |
Hypertension, dyslipidemia, osteoporosis, postoperative Mallory–Weiss syndrome, suspected aspiration pneumonia |
Fever, tachycardia |
Bowel obstruction |
Cefotiam (4 d), SAM (15 d), intestinal resection |
Alive, discharged (44 d) |
| 11 |
80s/F |
Osteoporosis, dyslipidemia |
Abdominal pain |
Perforated appendicitis, peritonitis, intra-abdominal abscess |
SAM (11 d), SAM and MTZ (8 d), appendectomy |
Alive, discharged (19 d) |
| 12 |
70s/M |
Cerebral infarction history, cholecystectomy history |
Chills, fever, vomiting |
Bacteremia of unknown origin |
Ciprofloxacin and MTZ (3 d), ceftriaxone and MTZ (10 d) |
Alive (outpatient) |
| 13 | 80s/M | Hypertension, cholecystectomy history, rectal cancer | Abdominal pain | Colorectal perforation | SAM (10 d), TZP (12 d), Hartmann procedure | Alive, discharged (53 d) |
*Bold text indicates cases in which multiple pathogens were detected as follows: 2, Alistipes onderdonkii, Bacteroides uniformis, Escherichia coli, and Pseudomonas nitroreducens; 5, A. putredinis and E. coli; 9, A. putredinis and Flavonifractor plautii; 10, A. indistinctus and Klebsiella pneumoniae; 11, A. onderdonkii and B. salyersiae; 13, A. finegoldii and A. ihumii. AMC, amoxicillin/clavulanic acid; CRBSI, catheter-related bloodstream infection; ID, identification; MTZ, metronidazole; SAM, ampicillin/sulbactam; transferred, transferred to another hospital; TZP, piperacillin/tazobactam. †Numbers in parentheses indicate duration of drug treatment. Most patients received multiple antimicrobial drugs; shown are the 2 used for the longest duration. ‡Patient had been experiencing abdominal distention caused by accumulation of ascites even before the onset of bacteremia.