A Rare Hip Infection Caused by <i>Cedecea lapagei</i> : An Unusual Presentation With Review of the Literature

Abstract

Cedecea lapagei is a Gram‐negative bacillus belonging to the Enterobacteriaceae family. Although rarely reported, it has been implicated in various infections including pneumonia, bacteremia, wound superinfection, urinary tract infections, ventriculitis, osteomyelitis, and peritonitis. To the best of our knowledge, we have documented a rare instance of an infection at the site of a left hip amputation caused by Cedecea lapagei , along with a literature review. A 37‐year‐old man who does not have any significant past medical history sustained a Grade III open fracture of the left femur, classified according to Duparc and Cauchoix, caused by a road traffic accident. After being admitted, the laboratory tests revealed leukocytosis with neutrophils dominating, anemia, and elevated C‐reactive protein (CRP) levels. Because of the high risk of infection, an amputation was performed on the affected limb, followed by the use of empirical antibiotics such as amoxicillin–clavulanate, gentamicin, and metronidazole. The clinical course was complicated by the rapid development of tissue necrosis and abscess formation. Cytobacteriological analysis was carried out on collected pus samples, which identified a Gram‐negative bacillus, confirmed as Cedecea lapagei using the BD Phoenix identification system. The antibacterial susceptibility test indicated that the strain was resistant to cefazolin, ceftazidime, ceftriaxone, cefepime, ertapenem, and colistin but was still able to respond to piperacillin/tazobactam, sulfamethoxazole–trimethoprim, and ciprofloxacin. The patient underwent drainage of purulent collections and surgical debridement of necrotic tissue, followed by intravenous ciprofloxacin 400 mg every 12 h, which resulted in favorable clinical outcomes. There is a lack of current knowledge about Cedecea lapagei ’s virulence factors and pathogenic potential due to its infrequent isolation (Rhoubi, 2025).