Rare case of urinary tract infection caused by Cedecea lapagei in a 93-year-old patient in southern Italy.

Abstract

Cedecea lapagei is a rare Gram-negative bacterium that has been infrequently associated with human infections. It is a non-encapsulated, facultative anaerobic organism that grows well in nonselective laboratory media and exhibits variable resistance patterns. Although Cedecea lapagei has been identified as a pathogen since 2006, reports of its clinical significance remain scarce, particularly in Europe. Here, we present the case of a 93-year-old male from Southern Italy, with multiple comorbidities and a history of urinary catheterization, who developed a urinary tract infection (UTI) caused by Cedecea lapagei. The patient was successfully treated with ciprofloxacin and fosfomycin, achieving clinical and microbiological healing. This report examines the substantial challenges associated with rare pathogens in clinical practice, focusing on the critical need for prompt and precise identification alongside tailored treatment strategies. Additionally, it highlights the pathogen's alarming multidrug resistance capabilities, underscoring the urgent need for robust antimicrobial stewardship programs and comprehensive research into its epidemiological behavior and resistance mechanisms. Incorporating rare pathogens into differential diagnoses, particularly for elderly patients with recurrent UTIs, could improve patient outcomes significantly. Finally, these findings expand the limited existing data on Cedecea lapagei infections, providing valuable insights into more precise diagnostic methodologies and tailored therapeutic approaches.