Paenibacillus Infection in a Pediatric Patient on ECMO

Abstract

Paenibacillus is a spore forming gram positive rod that is usually found in the environment. We describe a case of a patient who contracted this organism having never left the hospital after birth. This neonate contracted Paenibacillus septic shock requiring support with venous-arterial extracorporeal membrane oxygenation (ECMO) while still admitted to the hospital after birth. This patient initially presented in severe septic shock due to a Streptococcus agalactiae infection requiring hemodynamic support with ECMO. Following treatment for the Streptococcus agalactiae infection, and while still on ECMO support, the blood culture became positive for Paenibacillus. Given that our patient had never left the hospital after birth, the finding of this organism in the blood is unique. The primary defense against this bacterium is usually the skin. The only invasive procedure this patient had was ECMO cannulation which is done in a sterile fashion. Most species are susceptible to vancomycin, clindamycin, fluoroquinolones, aminoglycosides, carbapenems, penicillin, and cephalosporins. This patient was treated with penicillin G for 14 days for the S. agalactiae infection prior to the blood culture being positive for Paenibacillus. More than a hundred species had been identified in the genus Paenibacillus, however, few found to cause human infection. This case is unique as it is the first pediatric case with a Paenibacillus infection and the first pediatric case where this organism which rarely causes human infection was found in the blood culture of a patient on ECMO.