Yersinia Enterocolitica Bacteremia in a Chronic, Mildly Iron-Overloaded Dialysis Patient.
OBJECTIVE
To report an unusual case of Yersinia enterocolitica in a chronic, mildly iron-overloaded dialysis patient lacking other typical risk factors for bacteremia, who was treated successfully with a third-generation cephalosporin as monotherapy for a short duration of treatment.


METHODS
A 76-year-old dialysis-dependent man developed Y. enterocolitica bacteremia after 8 days of hospitalization. One month prior to presentation, his ferritin level was mildly elevated at 571.5 ng/mL, while receiving both intravenous and oral iron supplements. On day 14 of hospitalization, his ferritin level was acutely increased to 885.8 ng/mL. No risk factors commonly associated with Yersinia were present. He was treated successfully with a 14-day course of intravenous ceftriaxone, with negative surveillance blood cultures 2 months after treatment. One year after the infection, there was no evidence of recurrence, despite reinitiation of intravenous iron therapy, albeit with lower ferritin levels.


CONCLUSIONS
Y. enterocolitica is most commonly associated with patients receiving deferoxamine mesylate or those with iron overload, as the bacteria thrive in the presence of chelated iron. There has been limited experience with the use of third-generation cephalosporins as monotherapy for the treatment of Y. enterocolitica bacteremia; most of the data are from in vitro studies. Historical treatment choices have included aminoglycosides, doxycycline, trimethoprim/ sulfamethoxazole, and ciprofloxacin. Ceftriaxone was used in our patient because of the once-daily ease of administration, with complete resolution of bacteremia. Reinitiation of intravenous iron therapy, while keeping the ferritin levels below 300 ng/mL, allowed for treatment of his anemia without recurrence of infection.


CONCLUSIONS
This is the first English-language case of a dialysis patient with mild iron overload leading to Y. enterocolitica, despite having no known risk factors for the infection. Treatment success was obtained after a 14-day course of intravenous ceftriaxone. Intravenous iron was restarted without recurrence of infection, underscoring the importance of monitoring iron status in chronic dialysis patients.
Kari A Mergenhagen PharmD BCPS AQ-ID, Infectious Disease Clinical Pharmacy Specialist, VA Western New York Healthcare System, Buffalo, NY Kari.Mergenhagen@va.gov.
Kari A
KA
Mergenhagen
Amy L Telesz, PharmD student, School of Pharmacy, University at Buffalo, Buffalo.
Amy L
AL
Telesz
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy; D002443:Ceftriaxone / Q000627:therapeutic use; D006801:Humans; D019190:Iron Overload / Q000150:complications*; D008297:Male; D006435:Renal Dialysis; D012307:Risk Factors; D015009:Yersinia Infections / Q000150:complications* / Q000188:drug therapy; D015008:Yersinia enterocolitica
D000900:Anti-Bacterial Agents; D002443:Ceftriaxone