First report of hepatobiliary infection caused by Comamonas aquatica in a patient with cholangiocarcinoma: a case report

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Abstract Background Comamonas aquatica is a Gram-negative, aerobic, motile rod widely distributed in aquatic environments. It is rarely implicated in human infection, with only one previous case of bacteremia reported in the literature. The clinical spectrum and optimal management of C. aquatica infections remain poorly defined. Case presentation A 94-year-old man with underlying cholangiocarcinoma and malignant biliary obstruction presented with fever and jaundice. Blood and bile drainage fluid cultures both grew a Gram-negative rod. The isolate was identified as C. aquatica by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and confirmed by 16 S rRNA gene sequencing. Whole-genome sequencing confirmed the species identity. In vitro antimicrobial susceptibility testing revealed the strain remained sensitive only to carbapenems, amikacin, minocycline, chloramphenicol, and co-trimoxazole. The patient was successfully treated with meropenem and discharged in stable condition. Conclusions This is the first report of hepatobiliary infection caused by C. aquatica and only the second case overall. The case highlights the importance of multimodal laboratory identification for rare environmental pathogens and the clinical challenges posed by multidrug resistance. Clinicians should consider C. aquatica as a potential pathogen in immunocompromised hosts with biliary obstruction.

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