Posters
Presenting Author Academic/Professional Position
Felipe Diaz Jr.
Academic Level (Author 1)
Resident
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Medical Student
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Faculty
Discipline/Specialty (Author 3)
Internal Medicine
Discipline Track
Patient Care
Abstract Type
Case Report
Abstract
Background: Spontaneous bacterial peritonitis (SBP) is a serious infection commonly encountered in patients with decompensated cirrhosis and ascites, usually involving gram-negative organisms. Weissella cibaria is a gram-positive, catalase-negative, facultative anaerobe not typically associated with intra-abdominal infections. This case report highlights an unusual instance of SBP caused by W. cibaria in a cirrhotic patient, emphasizing the clinical importance of identifying atypical organisms and discussing implications for antimicrobial stewardship in vulnerable populations.
Case Presentation: A 65-year-old woman with decompensated nonalcoholic steatohepatitis (NASH) cirrhosis status post-transjugular intrahepatic portosystemic shunt (TIPS) placement and recurrent ascites requiring weekly paracentesis presented with altered mental status following administration of oral lorazepam by her daughter. On admission, the patient was hypertensive and tachycardic with leukocytosis (WBC 12.0), elevated ammonia (150 µmol/L), and signs of sepsis. Physical examination revealed diffuse abdominal tenderness. Initial management included ceftriaxone for presumed SBP. Diagnostic paracentesis yielded an ascitic fluid serum-ascites albumin gradient (SAAG) of 1.2 g/dL, consistent with portal hypertension. Culture of the ascitic fluid identified Weissella cibaria, with susceptibility testing showing resistance to vancomycin and susceptibility to penicillin, erythromycin, and clindamycin, though formal CLSI breakpoints are lacking. The patient transitioned from empiric ceftriaxone to piperacillin-tazobactam based on culture results and improved clinically, with resolution of abdominal symptoms and encephalopathy. She completed a seven-day course of piperacillin-tazobactam with full recovery and no complications. Repeat labs showed normalization of WBC and ammonia levels, and the patient completed a full course of antibiotics. She was discharged in stable condition, with plans for outpatient follow-up.
Conclusions: This case is the first reported instance of SBP due to Weissella cibaria in the United States. The organism, while typically found in fermented foods and the human gastrointestinal tract, may act as an opportunistic pathogen in immunocompromised individuals, such as those with decompensated cirrhosis. The case underscores the value of culture-directed therapy, especially when standard empirical treatments may not cover atypical organisms. Increased awareness of uncommon pathogens like W. cibaria is essential for guiding appropriate antimicrobial therapy and improving outcomes in vulnerable populations.
Presentation Type
Poster
Recommended Citation
Reinoso, Janetly; Diaz, Felipe Jr; and Campo Maldonado, Jose E., "An Unusual Case of Spontaneous Bacterial Peritonitis Due to Weissella cibaria in a Patient with Decompensated Cirrhosis" (2025). Research Colloquium. 41.
https://scholarworks.utrgv.edu/colloquium/2025/posters/41
An Unusual Case of Spontaneous Bacterial Peritonitis Due to Weissella cibaria in a Patient with Decompensated Cirrhosis
Background: Spontaneous bacterial peritonitis (SBP) is a serious infection commonly encountered in patients with decompensated cirrhosis and ascites, usually involving gram-negative organisms. Weissella cibaria is a gram-positive, catalase-negative, facultative anaerobe not typically associated with intra-abdominal infections. This case report highlights an unusual instance of SBP caused by W. cibaria in a cirrhotic patient, emphasizing the clinical importance of identifying atypical organisms and discussing implications for antimicrobial stewardship in vulnerable populations.
Case Presentation: A 65-year-old woman with decompensated nonalcoholic steatohepatitis (NASH) cirrhosis status post-transjugular intrahepatic portosystemic shunt (TIPS) placement and recurrent ascites requiring weekly paracentesis presented with altered mental status following administration of oral lorazepam by her daughter. On admission, the patient was hypertensive and tachycardic with leukocytosis (WBC 12.0), elevated ammonia (150 µmol/L), and signs of sepsis. Physical examination revealed diffuse abdominal tenderness. Initial management included ceftriaxone for presumed SBP. Diagnostic paracentesis yielded an ascitic fluid serum-ascites albumin gradient (SAAG) of 1.2 g/dL, consistent with portal hypertension. Culture of the ascitic fluid identified Weissella cibaria, with susceptibility testing showing resistance to vancomycin and susceptibility to penicillin, erythromycin, and clindamycin, though formal CLSI breakpoints are lacking. The patient transitioned from empiric ceftriaxone to piperacillin-tazobactam based on culture results and improved clinically, with resolution of abdominal symptoms and encephalopathy. She completed a seven-day course of piperacillin-tazobactam with full recovery and no complications. Repeat labs showed normalization of WBC and ammonia levels, and the patient completed a full course of antibiotics. She was discharged in stable condition, with plans for outpatient follow-up.
Conclusions: This case is the first reported instance of SBP due to Weissella cibaria in the United States. The organism, while typically found in fermented foods and the human gastrointestinal tract, may act as an opportunistic pathogen in immunocompromised individuals, such as those with decompensated cirrhosis. The case underscores the value of culture-directed therapy, especially when standard empirical treatments may not cover atypical organisms. Increased awareness of uncommon pathogens like W. cibaria is essential for guiding appropriate antimicrobial therapy and improving outcomes in vulnerable populations.
