Pseudomonas otitidis bacteremia following endoscopic biliary intervention: A rare case report and review of the literature.

BACKGROUND: Pseudomonas otitidis is primarily associated with ear infections; invasive disease is exceedingly rare, with only three reported cases of bacteremia in immunocompromised patients. We report the first known case of P. otitidis bacteremia following endoscopic biliary procedures. CASE PRESENTATION: An 86-year-old woman was admitted for evaluation of elevated levels of hepatobiliary enzymes and intrahepatic bile duct dilation. On the day of admission, endoscopic retrograde cholangiopancreatography complicated by periampullary perforation required conservative management. She developed high-grade fever on day 16. Blood cultures showed growth of gram-negative rods, which were later identified as P. otitidis using matrix-assisted laser desorption ionization time-of-flight mass spectrometry and 16S rRNA sequencing. The presumed source of infection was biliary tract infection. Meropenem treatment was initiated because the isolate was phenotypically susceptible to meropenem, and the patient's condition improved rapidly. Therapy was subsequently switched to ceftazidime, and the patient was discharged without recurrence. CONCLUSION: We report a novel case of P. otitidis bacteremia following endoscopic biliary procedures. Although P. otitidis has been detected in clinical specimens, bacteremia is extremely rare. Clinicians should recognize that P. otitidis can cause bacteremia and biliary tract infection.