Rhizobium radiobacter bloodstream infection associated with long-term central venous access in an infant with Pompe disease.

Rhizobium radiobacter (formerly Agrobacterium tumefaciens) is an environmental Gram-negative bacillus increasingly recognized as an opportunistic human pathogen, particularly in association with indwelling medical devices. Bloodstream infections (BSI) caused by this organism are rarely reported in children. We describe a 10-month-old girl with infantile-onset Pompe disease undergoing weekly enzyme replacement therapy (ERT) via central venous catheter who presented with fever and clinical deterioration 72 hours after infusion. Initial inflammatory markers were not significantly elevated, and multiplex molecular assays were negative for bacterial pathogens. Blood culture obtained from the catheter became positive after 25 hours, yielding Gram-negative bacilli subsequently identified as R. radiobacter. The isolate showed susceptibility to aminoglycosides, carbapenems, and fluoroquinolones, with intermediate susceptibility to piperacillin/tazobactam. Targeted antimicrobial therapy led to rapid clinical improvement and clearance of bacteremia without catheter removal. This case highlights both the pathogenic potential of uncommon environmental microorganisms in fragile children with long-term intravascular devices and the continuing diagnostic value of conventional blood cultures, particularly when rapid molecular assays are negative. Our experience also supports the possibility of catheter salvage in clinically stable patients responsive to appropriate antimicrobial therapy.