Chromobacterium violaceum infection: A clinical review of an important but neglected infection

Background: Increasing reported cases with Chrombacterium violaceum infection has been noticed in recent decades. It is noteworthy for its difficult-to-treat entity characterized by a high frequency of sepsis, easily distantant metastasis, multidrug-resistance, and frequent relapse, and high mortality rate. Methods: The English-language literature was reviewed from 1952 through December 2009 by an electronic view via the PubMed and Medline databases and manual searches. Results: One hundred and six patients with Chrombacterium violaceum infection from the literature were studied. The four leading clinical manifestations reviewed in the published literature, in the order of frequency, were fever (100%), sepsis (82%), skin lesions (67.9%), and abdominal pain (31.1%). Localized abscess was found in 52 patients (49%) and liver was the mostly common involved organ. Fifty-six patients (53%) were dead. Almost all of the penicillin, ampicillin, and first and second-generation cephalosporins exhibited totally resistant to Chrombacterium violaceum. The most important risk factors in mortality in 61 patients with Chrombacterium violaceum bacteremia were at a young age (p = 0.0789), presence of localized abscess (p = 0.030), shorter clinical course (p < 0.001), and inappropriate antimicrobial treatment (p < 0.001). Seven patients (6.6%) experienced of relapse or reinfection, with a median interval of 135 days (range, 4 to 1095 days). Conclusions: A high index of suspicion for Chromobacterium violaceum infection is required along with prompt diagnosis, optimal antimicrobial therapy, and adequate therapeutic duration for a successful therapy