Is Chryseobacterium indologenes a shunt-lover bacterium? A case report and review of the literature.

Chryseobacterium indologenes is a non-fermentative Gram-negative bacillus formerly belonging to the Flavobacterium genus. It is widely found in water and soil, also on wet surfaces of the hospital environment. It rarely causes infections and is usually associated with altered immune status or indwelling devices. We present a case of ventriculoperitoneal shunt infection caused by C. indologenes in a premature pediatric patient. A six-month-old male infant with congenital hydrocephalus and ventriculoperitoneal shunt was admitted with complaints of irritability, high fever and projectile vomiting. He was diagnosed as suffering from meningitis based on the clinical symptoms and laboratory findings of cerebrospinal fluid. The ventriculoperitoneal shunt was externalized and cerebrospinal fluid samples were sent for bacterial cultures. The isolated bacterium was identified as C. indologenes by conventional methods and the BD Phoenix™ 100 (Becton Dickinson, MD, USA) fully automated microbiology system. Antimicrobial susceptibility testing was performed by the microdilution method and Kirby-Bauer's disk diffusion method according to the Clinical and Laboratory Standards Institute guidelines. The isolate was found susceptible to ciprofloxacin, levofloxacin, cefoperazone and trimethoprim-sulfamethoxazole, while it was resistant to amikacin, aztreonam, cefepime, ceftazidime, gentamicin, imipenem and ticarcillin-clavulanic acid. The treatment was started with trimethoprim-sulfamethoxazole and cefoperazone-sulbactam The ventriculoperitoneal shunt was then removed. The patient was fully healed after two weeks and discharged. Central nervous system infection is a rare form of C. indologenes infections. The case presented herein may make a useful contribution to the existing literature.