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Bacteremia caused by Propionibacterium (Propionimicrobium) lymphophilum
Bacteriemia producida por Propionibacterium (Propionimicrobium) lymphophilum
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class="elsevierStyleItalic">Propionibacterium</span> (<span class="elsevierStyleItalic">Propionimicrobium</span>) <span class="elsevierStyleItalic">lymphophilum</span>" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "48" "paginaFinal" => "49" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Fernando Cobo, José A. García-Salcedo, José María Navarro-Marí" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Fernando" "apellidos" => "Cobo" "email" => array:1 [ 0 => "fernando.cobo.sspa@juntadeandalucia.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José A." "apellidos" => "García-Salcedo" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "José María" "apellidos" => "Navarro-Marí" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Department of Microbiology and Instituto de Investigación Biosanitaria ibs.GRANADA, University Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "GENYO, Centre for Genomics and Oncological Research, Pfizer/University of Granada/Andalusian Regional Government, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bacteriemia producida por <span class="elsevierStyleItalic">Propionibacterium (Propionimicrobium) lymphophilum</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Propionibacterium (Propionimicrobium) lymphophilum</span> has undergone several name changes,<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">1,2</span></a> and the description of this microorganism has recently been amended.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> This pathogen forms part of human skin and urinary tract microbiota and has been associated with a very small number of infections in humans.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5</span></a> We recently published the first case of bacteremia caused by this bacterium who was isolated in pure culture from an elderly patient,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> and we now report another case obtained from a blood culture that was initially misidentified by MALDI-TOF MS.</p><p id="par0010" class="elsevierStylePara elsevierViewall">An 83-year-old man was admitted to the Trauma-Emergency Department of our hospital with head trauma. Two foci of subarachnoid hemorrhage were observed on cranial CT scan, and severe abdominal pain was reported by the patient, who was transferred to the General Emergency Department. The abdominal CT scan revealed distal ileus perforation with fecaloid peritonitis, and the clinical records showed a history of diabetes mellitus and Parkinson disease. The patient underwent abdominal surgery with resection and anastomosis of the involved small intestine. At admission, blood analysis results were normal but the patient had a fever (38<span class="elsevierStyleHsp" style=""></span>°C). Blood cultures were taken on the same day and at the same hour from each arm and delivered to the hospital microbiology laboratory. At this time, empirical therapy was initiated with meropenem (1<span class="elsevierStyleHsp" style=""></span>g/8<span class="elsevierStyleHsp" style=""></span>h) and linezolid (600<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h). The samples were inoculated onto the BACTEC FX 40 (Becton Dickinson, Franklin Lakes, NY) monitorization system for culture. On day 2 of incubation, both anaerobic bottles were found to be positive. The samples were subcultured in aerobic or anaerobic blood agar (BD Columbia Agar with 5% Sheep Blood, Becton Dickinson, Franklin Lakes, NY). All media were incubated at 37<span class="elsevierStyleHsp" style=""></span>°C, and AnaeroGen Compact (Oxoid Ltd., Wide Road, Basingstoke, UK) was used as anaerobic system. Gram staining of the blood cultures exhibited abundant Gram-positive coccobacilli; on the second day of incubation, abundant colonies of these microorganisms were observed in pure culture only in anaerobic blood agar medium. Application of MALDI-TOF MS version 9 (8468 msp) (Bruker Biotyper, Billerica, MA) identified the strain as <span class="elsevierStyleItalic">Peptoniphilus indolicus</span> (score 1.86). Given the relatively low score, the strain was sent to the Center of Genomic and Oncologic Research (GENYO, Granada, Spain) for 16S rRNA gene sequence analysis using a previously reported method.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> A fragment of 1482<span class="elsevierStyleHsp" style=""></span>bp was obtained, yielding 99.3% similarity with the <span class="elsevierStyleItalic">P. lymphophilum</span> type strain JCM 5829 Gene Bank sequence (AB729070). The 16S sequence was also submitted to the GenBank (accession number: MT126739).</p><p id="par0015" class="elsevierStylePara elsevierViewall">The E-test was employed for antimicrobial susceptibility evaluation, applying the 2020 EUCAST criteria<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> with the exception of moxifloxacin, for which the 2020 CLSI criteria<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> was used. MIC values were penicillin (0.032<span class="elsevierStyleHsp" style=""></span>mg/L), amoxicillin-clavulanate (<0.016<span class="elsevierStyleHsp" style=""></span>mg/L), piperacillin-tazobactam (<0.016<span class="elsevierStyleHsp" style=""></span>mg/L), clindamycin (>256<span class="elsevierStyleHsp" style=""></span>mg/L), meropenem (0.006<span class="elsevierStyleHsp" style=""></span>mg/L), imipenem (0.016<span class="elsevierStyleHsp" style=""></span>mg/L), moxifloxacin (0.38<span class="elsevierStyleHsp" style=""></span>mg/L), and metronidazole (>256<span class="elsevierStyleHsp" style=""></span>mg/L).</p><p id="par0020" class="elsevierStylePara elsevierViewall">Linezolid was withdrawn, and meropenem was changed to piperacillin-tazobactam (1<span class="elsevierStyleHsp" style=""></span>g/12<span class="elsevierStyleHsp" style=""></span>h) for 7 days. The patient became afebrile at 2 days after starting the antimicrobial treatment, and he was discharged one month later.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P. lymphophilum</span> is among the most infrequent anaerobic bacteria associated with human infection, and, to our knowledge, only four cases have been reported in the medical literature to date.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–6</span></a> Here, we report a second case of bacteremia due to <span class="elsevierStyleItalic">P. lymphophilum</span> isolated in pure culture. A key issue in relation to this microorganism is whether its isolation corresponds to a true pathogen, which is supported in the present case by its isolation in pure culture in both sets of blood cultures, which were taken using aseptic procedures. In this case, it can be considered a secondary bacteremia from an abdominal source.</p><p id="par0030" class="elsevierStylePara elsevierViewall">MALDI-TOF MS is used for fast routine analyses in clinical laboratories and may be highly useful for the identification of anaerobic microorganisms and for the detection of new species responsible for infection. However, results should be interpreted with caution, and this technique produced the initial misidentification of <span class="elsevierStyleItalic">P. indolicus</span> in the present case. Species identification is highly probable when the score is ≥2.0<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> but must be confirmed when the score is below this cutoff by employing other diagnostic techniques, such as 16SrRNA gene sequencing. Moreover, a new MALDI software update is recommended in order to improve the scoring.</p><p id="par0035" class="elsevierStylePara elsevierViewall">In conclusion, this is the second report of <span class="elsevierStyleItalic">P. lymphophilum</span> as cause of bacteremia isolated in pure culture and indicates that this pathogen can be responsible for severe infections. This case highlights the need to confirm results when low MALDI-TOF scores are obtained.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">Support for this research was provided by the <span class="elsevierStyleGrantSponsor" id="gs1">Ministerio de Agricultura, Alimentación y Medio Ambiente</span>, <span class="elsevierStyleGrantNumber" refid="gs1">SAF2015-71714-R</span> (MINECO/FEDER).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">Authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Funding" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Conflict of interest" ] 2 => array:2 [ "identificador" => "xack504892" "titulo" => "Acknowledgments" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bacteria associated with certain types of abnormal lymph glands" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.C. 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Performance Standards for antimicrobial susceptibility testing, 30th ed., CLSI supplement M100, CLSI 2020, Wayne PA." ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The value of MALDI-TOF MS for the identification of clinically relevant anaerobic bacteria in routine laboratories" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Nagy" 1 => "S. Becker" 2 => "M. Kostrzewa" 3 => "N. Barta" 4 => "E. Urbán" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/jmm.0.043927-0" "Revista" => array:6 [ "tituloSerie" => "J Med Microbiol" "fecha" => "2012" "volumen" => "61" "paginaInicial" => "1393" "paginaFinal" => "1400" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22700545" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack504892" "titulo" => "Acknowledgments" "texto" => "<p id="par0050" class="elsevierStylePara elsevierViewall">The authors are grateful to Guadalupe Garcia-Medina for technical support.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/0213005X/0000003900000001/v1_202101070915/S0213005X20302007/v1_202101070915/en/main.assets" "Apartado" => array:4 [ "identificador" => "8590" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Cartas científicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000003900000001/v1_202101070915/S0213005X20302007/v1_202101070915/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X20302007?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 14 | 1 | 15 |
| 2024 September | 42 | 5 | 47 |
| 2024 August | 35 | 1 | 36 |
| 2024 July | 26 | 6 | 32 |
| 2024 June | 28 | 3 | 31 |
| 2024 May | 19 | 3 | 22 |
| 2024 April | 22 | 3 | 25 |
| 2024 March | 46 | 5 | 51 |
| 2024 February | 46 | 7 | 53 |
| 2024 January | 28 | 3 | 31 |
| 2023 December | 45 | 1 | 46 |
| 2023 November | 42 | 7 | 49 |
| 2023 October | 38 | 3 | 41 |
| 2023 September | 28 | 2 | 30 |
| 2023 August | 30 | 0 | 30 |
| 2023 July | 24 | 3 | 27 |
| 2023 June | 42 | 3 | 45 |
| 2023 May | 33 | 1 | 34 |
| 2023 April | 41 | 6 | 47 |
| 2023 March | 41 | 2 | 43 |
| 2023 February | 42 | 6 | 48 |
| 2023 January | 37 | 9 | 46 |
| 2022 December | 41 | 10 | 51 |
| 2022 November | 37 | 6 | 43 |
| 2022 October | 52 | 21 | 73 |
| 2022 September | 33 | 17 | 50 |
| 2022 August | 38 | 14 | 52 |
| 2022 July | 40 | 7 | 47 |
| 2022 June | 35 | 30 | 65 |
| 2022 May | 24 | 17 | 41 |
| 2022 April | 54 | 11 | 65 |
| 2022 March | 54 | 16 | 70 |
| 2022 February | 19 | 7 | 26 |
| 2022 January | 49 | 14 | 63 |
| 2021 December | 132 | 23 | 155 |
| 2021 November | 23 | 15 | 38 |
| 2021 October | 34 | 31 | 65 |
| 2021 September | 16 | 19 | 35 |
| 2021 August | 41 | 18 | 59 |
| 2021 July | 32 | 12 | 44 |
| 2021 June | 1 | 0 | 1 |
| 2021 May | 1 | 0 | 1 |
| 2021 April | 4 | 8 | 12 |
| 2021 March | 8 | 0 | 8 |
| 2021 February | 30 | 6 | 36 |
| 2021 January | 66 | 27 | 93 |
| 2020 June | 0 | 2 | 2 |
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