Rare Parapneumonic Effusion Caused by Multidrug-Resistant <i>Cronobacter</i> <i>sakazakii</i>: A Case of Successful Treatment with Two-Week Course of Antibiotic Therapy

Introduction Cronobacter sakazakii, an opportunistic gram-negative bacillus, is known to induce meningitis in preterm infants, and enterocolitis and bacteremia in neonates and adults. However, the literature lacks documentation of parapneumonic effusion caused by this pathogen in adult patients. Case Presentation A 42-year-old male with a complex medical history, including chronic kidney disease, hypertensive cardiovascular disease, coronary artery disease, and type 2 diabetes mellitus, further complicated by a history of bilateral pleural effusion secondary to nephrosis requiring chest tube thoracostomy. He presented with a four-day history of productive cough and dyspnea. Initial evaluation and management focused on the fatal arrhythmia and subsequent encephalopathy, leading to intubation and extended hospitalization. The clinical course was further complicated by pneumonia and recurrence of pleural effusion, from which multidrug-resistant C. sakazakii was isolated using the conventional culture method. A two-week course of carbapenem and monobactam therapy yielded a favorable clinical outcome and resolution of the parapneumonic effusion. Conclusion This case report describes the first documented occurrence of multidrug-resistant C. sakazakii-induced parapneumonic effusion in a patient with complex comorbidities. Notably, a two-week antibiotic course effectively resolved the effusion, precluding the need for a more invasive surgical intervention.