Emerging challenges of Cedecea lapagei infection: a rare case of pneumonia with bacteremia and literature review

Cedecea lapagei is a rare opportunistic pathogen that can colonize environmental surfaces and form biofilms. Despite its unclear clinical relevance, it has been linked to bacteremia, pneumonia, urinary tract, and wound infections, particularly in immunocompromised individuals. Herein, we describe a rare case of C. lapagei bacteremia characterized by markedly limited therapeutic options and contextualize it within the existing literature. A 35-year-old woman with epilepsy presented with fever, dyspnea and worsening general condition. Thoracic computed tomography (CT) showed left-lung pneumonic infiltrates. Empirical therapy with piperacillin/tazobactam plus clarithromycin was started, but progressive respiratory distress required intensive care. Blood-cultures grew C. lapagei, identified using the BD Phoenix 100 (Becton Dickinson, USA). C. lapagei belongs to the Enterobacteriaceae family. European Committee on Antimicrobial Susceptibility Testing (EUCAST) has defined breakpoints for antimicrobial susceptibility at the family level; however, species-specific breakpoints for C. lapagei are not available. A methodological appraisal of published Cedecea cases shows that few reports describe the criteria used for susceptibility testing. Herein, we interpreted susceptibility according to EUCAST breakpoints established for Enterobacterales. Despite appropriate therapy, the outcome was fatal. This case reinforces that C. lapagei, though rare, poses a growing threat through its expanding resistance and capacity to cause severe community-onset infections. A rare infection caused by Cedecea lapagei bacteria: lessons from one patient’s story. Cedecea lapagei is a very rare type of bacteria. It can live on hospital surfaces and some medical devices because it forms protective layers called “biofilms.” This bacterium usually does not make healthy people sick, but it can cause serious infections in people with weak immune systems or long-term illnesses. In this report, we describe a 35-year-old woman who developed pneumonia (a lung infection). Her breathing got worse, and she was moved to intensive care. Blood tests showed that she had an infection with Cedecea lapagei. The laboratory confirmed this finding and tested which antibiotics could work. Based on the results, her doctors changed the treatment to stronger antibiotics. Even though the infection was cleared from her blood, her overall condition declined because of her other health problems, and she sadly passed away. So far, only a few infections caused by this bacterium have been reported around the world. Some of these were caught in hospitals, but others started in the community. Doctors and laboratory staff should be aware of this rare germ because it can resist many antibiotics. Early testing and the right treatment choices are very important to help patients recover.