Fulminant Aeromonas caviae bacteremia with migratory myalgia: a case report of a CTX-M-3-producing multidrug-resistant strain
Abstract
Background: Aeromonas caviae is an emerging waterborne pathogen of increasing clinical concern, particularly regarding antimicrobial resistance. While extended-spectrum β-lactamase (ESBL) genes such as blaCTX-M are well-documented in Enterobacterales, they remain uncommon in A. caviae. We report a rare case of fulminant A. caviae bacteremia with atypical clinical manifestations and a complex genomic resistome.
Case presentation: A 71-year-old man without formal immunodeficiency but with predisposing vulnerabilities (advanced age, prior subtotal gastrectomy) presented with fulminant bacteremia progressing to septic shock and unusual migratory myalgia following a minor paddy field injury. Initial empirical ertapenem therapy at a referring hospital was clinically ineffective. Blood cultures isolated A. caviae with multidrug resistance. Whole-genome sequencing (WGS)-based phylogenomic analysis confirmed species identity (clustering with A. caviae type strain NCTC 12244; bootstrap 100%; average nucleotide identity 98.09%), distinguishing it from closely related species (A. dhakensis, A. hydrophila, A. veronii). WGS identified ESBL genes blaCTX-M-3, blaTEM-1B, and blaOXA-10, alongside aac(6')-Ib-cr and tet(A). The isolate remained susceptible to amikacin and representative carbapenems (imipenem, meropenem). Therapy was successfully switched to biapenem, achieving rapid clinical recovery and microbiological clearance.
Conclusions: A. caviae, an environmental organism, can harbor…
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