Emerging challenges of Cedecea lapagei infection: a rare case of pneumonia with bacteremia and literature review.

Cedecea lapagei is a rare opportunistic pathogen that can colonize environmental surfaces and form biofilms. Despite its unclear clinical relevance, it has been linked to bacteremia, pneumonia, urinary tract, and wound infections, particularly in immunocompromised individuals. Herein, we describe a rare case of C. lapagei bacteremia characterized by markedly limited therapeutic options and contextualize it within the existing literature. A 35-year-old woman with epilepsy presented with fever, dyspnea and worsening general condition. Thoracic computed tomography (CT) showed left-lung pneumonic infiltrates. Empirical therapy with piperacillin/tazobactam plus clarithromycin was started, but progressive respiratory distress required intensive care. Blood-cultures grew C. lapagei, identified using the BD Phoenix 100 (Becton Dickinson, USA). C. lapagei belongs to the Enterobacteriaceae family. European Committee on Antimicrobial Susceptibility Testing (EUCAST) has defined breakpoints for antimicrobial susceptibility at the family level; however, species-specific breakpoints for C. lapagei are not available. A methodological appraisal of published Cedecea cases shows that few reports describe the criteria used for susceptibility testing. Herein, we interpreted susceptibility according to EUCAST breakpoints established for Enterobacterales. Despite appropriate therapy, the outcome was fatal. This case reinforces that C. lapagei, though rare, poses a growing threat through its expanding resistance and capacity to cause severe community-onset infections.