SHM Converge Scientific Abstract ePoster Gallery-From Gardening to Bacteremia: The Unlikely Role of Burkholderia Gladioli

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This case report describes a 37-year-old man with intravenous drug use and recurrent skin infections who presented with bloody diarrhea, nausea, chest pain, and tender nodular lesions on both forearms. Initial evaluation, including labs and imaging, was largely unrevealing, and he was discharged on cephalexin for presumed cellulitis. He was recalled when blood cultures became positive: both initial sets ultimately grew <strong>Burkholderia gladioli</strong>, a rare gram-negative environmental organism, along with Microbacterium in one set.

He was restarted on broad-spectrum antibiotics, then narrowed to <strong>meropenem and vancomycin</strong> after infectious disease consultation. Dermatology performed a punch biopsy of the skin lesions, and culture from the biopsy also grew <strong>B. gladioli</strong>, supporting hematogenous seeding to the skin. Repeat surveillance blood cultures were negative. The source of infection remained unclear. He improved clinically and was discharged on <strong>oral levofloxacin</strong> based on susceptibility testing.

The report emphasizes that <strong>B. gladioli bacteremia is extremely rare</strong> and usually affects immunocompromised patients, though this patient lacked typical predisposing factors. Its presentation can mimic more common infections such as cellulitis or bacteremia, making diagnosis challenging. Treatment is also difficult because the organism may be resistant to many antibiotics, including aminoglycosides and colistin, so <strong>susceptibility testing is essential</strong>.

Key takeaway: clinicians should consider unusual pathogens like <strong>Burkholderia gladioli</strong> when cultures grow gram-negative rods, especially when skin lesions accompany bacteremia, even in patients without classic risk factors.

Asset Subtitle

Evan Raff

Meta Tag

Author List Evan Raff, Hannah Pollock, Meg Johnson, Mukhtar Adem, Rachel Lile-King

Category Clinical Vignettes

Concept Burkholderia gladioli

Concept Bacteremia

Concept Cutaneous Infection

Concept Blood Culture

Concept Antibiotic Resistance

Distinguished Non-Finalist

Presenter Organization University of North Carolina School of Medicine

Presenting Author Evan Raff

Track Adult

Keywords

Burkholderia gladioli

bacteremia

intravenous drug use

skin infections

tender nodular lesions

hematogenous seeding

meropenem

vancomycin

levofloxacin

antibiotic susceptibility testing

Burkholderia gladioli

Bacteremia

Cutaneous Infection

Blood Culture

Antibiotic Resistance