Pace Wetstein, BS,
Premedical Student
Stevenson University, Owings Mills, MD
Baltimore, MD
Disclosure information not submitted.
Adrian Holloway, MD
Pediatric Critical Care Attending
University of Maryland Medical Center, United States
Disclosure information not submitted.
Nan Garber, MD
Pediatric Critical Care Attending
University of Maryland Medical Center, United States
Disclosure information not submitted.
Ripal Patel
University of Maryland School of Medicine
Baltimore, MD
Disclosure information not submitted.
Title: Paenibacillus infection in a pediatric patient on ECMO
Case Report Body:
Introduction: We report a case of Paenibacillus septic shock and multiple organ dysfunction syndrome in a term neonate, requiring cannulation onto VA-ECMO shortly after birth.
Description: This neonate was born via stat C-section for a non-reassuring fetal heart rate. Meconium-stained fluid was noted during delivery. After birth, she was noted to have significant respiratory distress, hypotension, and neurologic depression requiring intubation and vasoactive medications. The first ABG revealed a pH 6.97. In the NICU, the infant was in severe septic shock while on maximal medical therapy requiring mechanical support with VA-ECMO for refractory septic shock at 10 hours of life. The first blood culture was positive for streptococcus agalactiae on day of life 1, for which she was treated with cefotaxime and ampicillin. The antibiotics were subsequently changed to penicillin G for 14 days. Daily blood cultures were consistently negative by day of life 2. Blood cultures became positive again at day of life 10 with Paenibacillus. Despite the addition of vancomycin, blood cultures remained positive for the duration of her ECMO course. Patient developed multi organ dysfunction after the positive blood culture with Paenbacillus. Due to the evolving and progressive MODS and inability to clear the Paenibacillus bacteremia, the patient was decannulated from ECMO. Death occurred approximately 12 hours later due to refractory hypoxemic and hypercarbic respiratory failure and septic shock. An autopsy was performed with the final cause of death considered to be multi-organ failure due to sepsis.
Discussion: Paenibacillus bacterium infections are largely documented in adults and premature neonates. They are infrequent and generally have a favorable patient outcome. Our case is unique, as it is the first case with a Paenibacillus infection found in the blood culture of a patient on ECMO. The infection in our patient was resistant to ampicillin, despite the report of its sensitivity to penicillin. There is also no explanation of where the patient contracted the bacterium, as it is usually found in the environment; the only invasive procedure performed was ECMO cannulation. Also unique to our patient is the multi-system organ failure, which led to death, while most reported cases predict patient recovery.