title: Clinical implications ofParacoccus yeeiibacteremia in a patient with decompensated cirrhosis.
abstract: Infections in patients with cirrhosis are common among those who develop variceal hemorrhage. Prophylactic antimicrobial treatment with third generation cephalosporins is recommended in patients with advanced cirrhosis and gastrointestinal hemorrhage. However no infectious source is identified in up to 50% of patients with cirrhosis and clinical sepsis. We report the first case ofParacoccus yeeiibacteremia in a patient with decompensated cirrhosis who presented with variceal hemorrhage. This rare gram negative organism that occurs naturally in the soil has been difficult to isolate until recent technological advances and may not be susceptible to third generation cephalosporins. Our case reinforces the challenges in isolating rare infections in patients with cirrhosis, the need to consider uncommon organisms in infected but culture negative patients with cirrhosis, and the importance of optimizing antimicrobials to reduce the incidence of drug resistant organisms.
authors.affiliation: Yale University School of Medicine, Department of Internal Medicine, 330 Cedar Street, Boardman 110, PO Box 208056, New Haven, CT, 06520-8056 USA.
authors.forename: Jordan
authors.initials: J
authors.lastname: Sack
authors.affiliation: Yale University School of Medicine, Department of Laboratory Medicine, New Haven, CT, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Peaper
authors.affiliation: Yale University School of Medicine, Section of Digestive Diseases, New Haven, CT, USA.
authors.forename: Pramod
authors.initials: P
authors.lastname: Mistry
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
authors.forename: Maricar
authors.initials: M
authors.lastname: Malinis
keywords: Bacteremia; Decompensated cirrhosis; Gram negative; MALDI-TOF; Paracoccus yeeii