P1316 - Short Bowel Syndrome and Parenteral Nutrition: A Challenging Case of Recurrent Bacteremia and Fungemia

Deepak Kumar, MBBS, MD¹, Monica Arora, DO², Sunny Kumar, MD³, Anila Mahesh, MD⁴, Ramona Rajapakse, MD, FACG²
1Northwell Health, Port Jefferson, NY; 2Mather Hospital, Northwell Health, Port Jefferson, NY; 3Wright Center for Graduate Medical Education, Scranton, PA; 4Geisinger Wyoming Valley Medical Center, Duryea, PA

Introduction: Short bowel syndrome (SBS) often necessitates chronic total parenteral nutrition (TPN) via central venous catheters, increasing the risk of catheter-related bloodstream infections (CRBSIs). We present a challenging case of a 76-year-old female with SBS who developed multidrug-resistant Gram-positive bacteremia and fungemia, highlighting diagnostic and therapeutic complexities in TPN-dependent patients.

Case Description/

Methods: A 76-year-old female with SBS (TPN-dependent via a peripherally inserted central catheter [PICC] placed almost one year ago), history of small bowel obstructions (status post colostomy and ileostomy also a year ago), atrial fibrillation (on apixaban), hypertension, hyperlipidemia, fibromyalgia, hypothyroidism, and GERD presented with fever (100.7°F), chills, rigors, and malaise. In the ED, she developed hypotensive septic shock. The PICC was identified as the likely infection source and removed, with a right internal jugular line placed for vasopressors and TPN continuation. Blood cultures revealed Staphylococcus epidermidis and Mycobacterium mucogenicum, both catheter associated. Skin cultures were negative, and transthoracic echocardiography ruled out endocarditis. Empiric therapy with meropenem and caspofungin was adjusted to minocycline for 7 days, followed by ciprofloxacin 500 mg orally every 12 hours for 4 weeks, based on susceptibility profiles showing multidrug resistance to antituberculous agents but sensitivity to ciprofloxacin, minocycline, and linezolid. Fevers resolved within one week, with clinical improvement achieved through multidisciplinary management involving gastroenterology, infectious disease, and nutrition services.

Discussion: CRBSIs are a significant complication in SBS patients due to long-term TPN dependence. S. epidermidis, a common skin flora, and M. mucogenicum, a rare non-tuberculous mycobacterium, highlight the complexity of infections in this population. Multidrug resistance required tailored antibiotic therapy. Epidemiological data indicate M. mucogenicum accounts for ~24% of rapidly growing mycobacteria (RGM) isolates, primarily in immunocompromised hosts, with a low incidence (0.04 cases per 100,000). Prompt catheter removal, targeted antimicrobials, and nutritional optimization were critical to recovery. This case underscores the need for multidisciplinary approaches to manage CRBSIs in SBS patients.

Disclosures:
Deepak Kumar indicated no relevant financial relationships.
Monica Arora indicated no relevant financial relationships.
Sunny Kumar indicated no relevant financial relationships.
Anila Mahesh indicated no relevant financial relationships.
Ramona Rajapakse indicated no relevant financial relationships.

Deepak Kumar, MBBS, MD¹, Monica Arora, DO², Sunny Kumar, MD³, Anila Mahesh, MD⁴, Ramona Rajapakse, MD, FACG². P1316 - Short Bowel Syndrome and Parenteral Nutrition: A Challenging Case of Recurrent Bacteremia and Fungemia, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.