Abstract / Summary
BackgroundVentilator-associated pneumonia (VAP) is a common and serious consequence of prolonged mechanical ventilation in critically ill polytrauma patients, especially those with underlying comorbidities such as diabetes mellitus. Although VAP is often caused by gram-negative bacilli and Staphylococcus aureus, infection due to fastidious organisms is uncommon and may delay microbiological diagnosis. Granulicatella adiacens, formerly categorized among the nutritionally variant streptococci (NVS), is a fastidious commensal of the oral and genitourinary tract that is most commonly associated with infective endocarditis and bacteremia, whereas pulmonary infections are exceptionally rare.Case presentationWe present a case report of a 50-year-old diabetic male who sustained severe head, thoracic, and skeletal injuries in a high-impact two-wheeler RTA. He acquired ventilator-associated pneumonia with progression to septic shock on the ICU course. The initial cultures (blood, urine, ET aspirate) were sterile, but the following bronchoalveolar lavage G. adiacens as the predominant organism on enriched media, identifying it as the probable etiological agent. A repeat blood culture, obtained on day 4 because of suspected sepsis, subsequently also grew G. adiacens after the patient's death. The patient, in spite of mechanical ventilation, vasopressors, renal replacement therapy, and broad-spectrum antibiotics, developed multi-organ dysfunction and succumbed on ICU day 5.ConclusionThe case brings to the fore the potential possibility of G. adiacens to cause fatal opportunistic infections in polytrauma victims when invasive ICU therapy and metabolic derangements converge. Early suspicion, prompt interventions like BAL sampling, and enriched media or molecular diagnostics can facilitate the detection of fastidious pathogens in culture-negative sepsis, thus facilitating therapeutic targeting and optimizing outcomes.