(Kiosk 1) It’s Complicated: A Rare Case of Citrobacter Braakii Bacteremia Following PEG Tube Placement in an Immunocompetent Patient

Case Diagnosis: This is a 62-year-old female with dysphagia following brain meningioma resection preceding PEG tube placement complicated by rare infection successfully treated during acute inpatient rehabilitation admission.

Case Description or Program Description: A 62-year-old female who was functionally independent at baseline was found to have a brain meningioma with cervicomedullary compression. She was admitted to the hospital and underwent a left suboccipital craniotomy for meningioma resection. Her postoperative course was complicated by persistent dysphagia. She and her family declined PEG tube placement initially and she continued to receive enteral feeds via nasogastric tube. Once medically stabilized, she was transferred to the acute inpatient rehabilitation hospital to continue daily intensive therapies.

Setting: Acute Inpatient Rehabilitation Hospital

Assessment/Results: Due to persistent swallowing deficits despite therapies, the patient elected for PEG tube placement to facilitate discharge home. The evening following PEG tube placement, the patient became febrile with hypotension and tachycardia. After 24 hours blood cultures grew Citrobacter braakii. She was treated with intravenous (IV) cefepime for 7 days. Repeat blood cultures 48 hours later showed no growth. She had no further complications during her inpatient rehab admission and was safely discharged home.

Discussion (relevance): Dysphagia remains a common complication of several conditions that afflict patients in the acute inpatient rehabilitation setting, thus Physiatrists are often managing patients with percutaneous feeding tubes. This case should encourage the clinician to remain aware of the increased risk for infection in patients who have recently undergone procedures involving manipulation of the GI tract, such as PEG tube placement, and offer a clear treatment plan.

Conclusions: This unique case of C. braakii infection after PEG tube placement provides insight into a rare source of infection that can be encountered in the inpatient rehabilitation setting. The successful treatment in this case with IV cefepime adds to the limited available literature for clinicians treating patients who develop C. braakii infection.