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Bacteremia due to Cellulosimicrobium cellulans associated with central catheter for hemodialysis
Bacteriemia asociada a catéter central para hemodiálisis debida a Cellulosimicrobium cellulans
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Núñez García, Miguel Ángel Bratos-Pérez" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Eleda" "apellidos" => "Coletta-Griborio" "email" => array:1 [ 0 => "ele_colett@hotmail.com" ] "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" => "Guadalupe" "apellidos" => "Rodriguez Portela" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Jesús M." "apellidos" => "Núñez García" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Miguel Ángel" "apellidos" => "Bratos-Pérez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Hospital Clínico Universitario de Valladolid, Valladolid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Facultad de Medicina de Valladolid, Hospital Clínico Universitario de Valladolid, Valladolid, 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 asociada a catéter central para hemodiálisis debida a <span class="elsevierStyleItalic">Cellulosimicrobium cellulans</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report a case of an 80 year-old female patient with history of hypertension and chronic renal failure secondary to nephrosclerosis on hemodialysis through permanent central venous catheter.</p><p id="par0010" class="elsevierStylePara elsevierViewall">In June 2013, during a hemodialysis session, the patient presented general discomfort, tremor and discrete acrocianosis; neither fever nor other abnormalities on physical examination were found.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Catheter blood cultures were obtained, for aerobic and anaerobic microorganisms, and antibiotic treatment was initiated with vancomycin and ceftazidime. After five days of incubation, blood cultures were reported as negative and therefore antibiotic treatment was discontinued.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, a week later, symptoms reappeared with no apparent origin, so blood cultures were extracted through the central venous catheter (for aerobic and anaerobic microbes). They were incubated into the BACTEC (Becton Dickinson) system and after 18<span class="elsevierStyleHsp" style=""></span>h of incubation, they resulted positive. Gram staining was performed and branched gram positive bacilli were observed. The recovered bacteria from blood cultures were subcultured in blood agar, chocolate agar and Mac Conkey plates, and incubated at 37<span class="elsevierStyleHsp" style=""></span>°C in a 5% CO<span class="elsevierStyleInf">2</span> atmosphere. Twenty-four hours later, 2<span class="elsevierStyleHsp" style=""></span>mm diameter, bright yellow, irregular edges and convex surface colonies were observed. They were identified as <span class="elsevierStyleItalic">Cellulosimicrobium cellulans</span> by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) (Bruker Daltonics). An API <span class="elsevierStyleItalic">Coryne</span> gallery was conducted to compare the results, identifying <span class="elsevierStyleItalic">C. cellulans</span> with a reliability of 99.9%. The identification of the genus was confirmed by sequencing the 16S rRNA, showing a 100% similarity with <span class="elsevierStyleItalic">C. cellulans</span> and a 99.8% for <span class="elsevierStyleItalic">C. funkei</span> (<span class="elsevierStyleItalic">Colección Española de Cultivos Tipo</span>, CECT).</p><p id="par0025" class="elsevierStylePara elsevierViewall">Antimicrobial susceptibility tests were performed using MicroScan microdilution panels, which were interpreted according to CLSI criteria for <span class="elsevierStyleItalic">Nocardia</span> and others aerobic Actinomicetes breakpoints. The inoculum suspention was made adjusting the turbidity to 0.5 McFarland standard and incubated at 37<span class="elsevierStyleHsp" style=""></span>°C for 24<span class="elsevierStyleHsp" style=""></span>h. The results of antimicrobial susceptibility testing for the following antimicrobial drugs were: susceptible to amoxcicillin/clavulanate (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>4/2<span class="elsevierStyleHsp" style=""></span>mg/L), imipenem (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mg/L), moxifloxacin (MIC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mg/L), cotrimoxazole (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>2/38<span class="elsevierStyleHsp" style=""></span>mg/L) and linezolid (MIC<span class="elsevierStyleHsp" style=""></span>≤<span class="elsevierStyleHsp" style=""></span>1<span class="elsevierStyleHsp" style=""></span>mg/L); and resistant to tobramycin (MIC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>8<span class="elsevierStyleHsp" style=""></span>mg/L), amikacin (MIC<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>16<span class="elsevierStyleHsp" style=""></span>mg/L), ciprofloxacin (MIC<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>mg/L). The CMI for vancomycin was ≤0.5<span class="elsevierStyleHsp" style=""></span>mg/L (there are no criteria for interpretation).</p><p id="par0030" class="elsevierStylePara elsevierViewall">A 4-week course of vancomycin, adjusted according to our patient renal function (1<span class="elsevierStyleHsp" style=""></span>g initially followed by 0.5<span class="elsevierStyleHsp" style=""></span>g at each dialysis session) was started. During the treatment, the patient presented several episodes of tremor. Control blood cultures were taken from the central venous catheter and from peripheral veins one week after finishing each treatment cycle, persisting positive after two -4 week cycles-. After three positive controls, it was decided to remove the catheter and blood cultures became negative.</p><p id="par0035" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Cellulosimicrobium cellulans</span>, formerly known as <span class="elsevierStyleItalic">Oerskovia xanthineolytica</span>, belongs to the order <span class="elsevierStyleItalic">Actinomycetales</span>, suborder <span class="elsevierStyleItalic">Micrococcineae</span>, family <span class="elsevierStyleItalic">Promicromonosporaceae</span>.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">1</span></a> It has a worldwide distribution and it is found in the environment mainly in the soil, water, plant residues, cut grass and in decomposed organic matter.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">2</span></a> It infects primarily immunocompromised patients but it has also been implicated in foreign body infections in immunocompetent patients with central venous catheters, peritoneal catheters, ventriculo-peritoneal shunts and prostheses. Moreover, it has been related to neonatal infections, bacteremia, peritonitis, meningitis, endocarditis, keratitis, pyonephrosis, soft tissue infection and tenosynovitis.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">They are branched gram-positive bacilli with irregular contours, growing in regular culture media at room temperature but faster at 37<span class="elsevierStyleHsp" style=""></span>°C, differentiating it from the genera <span class="elsevierStyleItalic">Corynebacterium</span> and <span class="elsevierStyleItalic">Nocardia</span>. These bacteria are aerobic and facultative anaerobic, non-motile, catalase positive, oxidase negative, reduces nitrate to nitrite, and hydrolyzes gelatin, urea and DNA. They have a fermentative metabolism using sugars such as glucose, ribose, sucrose, lactose and maltose. However, they do not ferment mannitol or sorbitol.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">4</span></a><span class="elsevierStyleItalic">Cellulosimicrobium cellulans</span> is phenotypically identified with API-<span class="elsevierStyleItalic">Coryne</span><span class="elsevierStyleSup">®</span>, and it can also be identified by 16S rRNA sequencing,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">5</span></a> or mass spectrometry.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">3</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">The treatment of choice in patients with normal renal function is vancomycin 1<span class="elsevierStyleHsp" style=""></span>g every 12<span class="elsevierStyleHsp" style=""></span>h or linezolid 600<span class="elsevierStyleHsp" style=""></span>mg every 12<span class="elsevierStyleHsp" style=""></span>h. Carbapenems and associations with rifampicin can also be used for antibiotic therapy.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">6</span></a> In our case, dosage had to be adjusted due to our patient renal impairment. Unfortunately, despite receiving a 4-week course treatment, the microorganism was still isolated in cultures. Complete healing was not achieved until catheter removal.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The catheter-related bacteremia case reports published in the literature were treated with antibiotics associations such us vancomycin and rifampicin, and complete cure was achieved.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> However, the optimal treatment is the withdrawal of the foreign body with specific antibiotics, except those cases where is complicated to attain a new vascular access. In these especial cases, it is recommended to attempt complete healing with only antibiotic treatment before removing the catheter,<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">7</span></a> as in the case of our patient. Two months later, the patient died of non-infectious causes.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0040" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The NCBI taxonomy database" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "S. 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"fecha" => "2015" "editorial" => "Antares" "editorialLocalizacion" => "Barcelona" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0070" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clearance of <span class="elsevierStyleItalic">Cellulosimicrobium cellulans</span> bacteremia in a child without central venous catheter removal" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "M.C. Rowlinson" 1 => "D.A. Bruckner" 2 => "C. Hinnebusch" 3 => "K. Nielsen" 4 => "J.G. Deville" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.02485-05" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol" "fecha" => "2006" "volumen" => "44" "paginaInicial" => "2650" "paginaFinal" => "2654" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16825406" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] "agradecimientos" => array:1 [ 0 => array:4 [ "identificador" => "xack273986" "titulo" => "Acknowledgements" "texto" => "<p id="par0060" class="elsevierStylePara elsevierViewall">A Dra. Ana Rodriguez Fernandez and Dr. Juan Manuel Diaz Romero for their cooperation and support in carrying out the work.</p>" "vista" => "all" ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000003500000001/v2_201703180226/S2529993X17300126/v2_201703180226/en/main.assets" "Apartado" => array:4 [ "identificador" => "63562" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000003500000001/v2_201703180226/S2529993X17300126/v2_201703180226/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X17300126?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 22 | 4 | 26 |
| 2024 September | 57 | 11 | 68 |
| 2024 August | 50 | 9 | 59 |
| 2024 July | 35 | 14 | 49 |
| 2024 June | 30 | 10 | 40 |
| 2024 May | 30 | 7 | 37 |
| 2024 April | 27 | 19 | 46 |
| 2024 March | 76 | 4 | 80 |
| 2024 February | 40 | 4 | 44 |
| 2024 January | 52 | 7 | 59 |
| 2023 December | 77 | 15 | 92 |
| 2023 November | 49 | 10 | 59 |
| 2023 October | 67 | 19 | 86 |
| 2023 September | 26 | 1 | 27 |
| 2023 August | 52 | 4 | 56 |
| 2023 July | 83 | 4 | 87 |
| 2023 June | 67 | 7 | 74 |
| 2023 May | 113 | 10 | 123 |
| 2023 April | 85 | 5 | 90 |
| 2023 March | 71 | 9 | 80 |
| 2023 February | 62 | 5 | 67 |
| 2023 January | 62 | 7 | 69 |
| 2022 December | 39 | 6 | 45 |
| 2022 November | 65 | 10 | 75 |
| 2022 October | 39 | 4 | 43 |
| 2022 September | 39 | 11 | 50 |
| 2022 August | 52 | 19 | 71 |
| 2022 July | 33 | 14 | 47 |
| 2022 June | 34 | 7 | 41 |
| 2022 May | 59 | 11 | 70 |
| 2022 April | 36 | 10 | 46 |
| 2022 March | 52 | 20 | 72 |
| 2022 February | 35 | 12 | 47 |
| 2022 January | 65 | 13 | 78 |
| 2021 December | 43 | 13 | 56 |
| 2021 November | 49 | 14 | 63 |
| 2021 October | 76 | 7 | 83 |
| 2021 September | 61 | 17 | 78 |
| 2021 August | 71 | 8 | 79 |
| 2021 July | 36 | 13 | 49 |
| 2021 June | 22 | 7 | 29 |
| 2021 May | 53 | 6 | 59 |
| 2021 April | 130 | 8 | 138 |
| 2021 March | 68 | 8 | 76 |
| 2021 February | 38 | 10 | 48 |
| 2021 January | 66 | 9 | 75 |
| 2020 December | 78 | 12 | 90 |
| 2020 November | 49 | 6 | 55 |
| 2020 October | 37 | 6 | 43 |
| 2020 September | 54 | 13 | 67 |
| 2020 August | 73 | 14 | 87 |
| 2020 July | 53 | 9 | 62 |
| 2020 June | 37 | 6 | 43 |
| 2020 May | 52 | 13 | 65 |
| 2020 April | 43 | 11 | 54 |
| 2020 March | 68 | 8 | 76 |
| 2020 February | 75 | 7 | 82 |
| 2020 January | 60 | 6 | 66 |
| 2019 December | 58 | 20 | 78 |
| 2019 November | 54 | 4 | 58 |
| 2019 October | 40 | 11 | 51 |
| 2019 September | 52 | 4 | 56 |
| 2019 August | 35 | 7 | 42 |
| 2019 July | 49 | 10 | 59 |
| 2019 June | 98 | 32 | 130 |
| 2019 May | 207 | 66 | 273 |
| 2019 April | 132 | 31 | 163 |
| 2019 March | 23 | 2 | 25 |
| 2019 February | 32 | 7 | 39 |
| 2019 January | 20 | 8 | 28 |
| 2018 December | 10 | 2 | 12 |
| 2018 November | 14 | 8 | 22 |
| 2018 October | 27 | 1 | 28 |
| 2018 September | 10 | 8 | 18 |
| 2018 August | 7 | 2 | 9 |
| 2018 July | 12 | 2 | 14 |
| 2018 June | 7 | 0 | 7 |
| 2018 May | 5 | 1 | 6 |
| 2018 April | 8 | 2 | 10 |
| 2018 March | 10 | 2 | 12 |
| 2018 February | 7 | 0 | 7 |
| 2018 January | 11 | 1 | 12 |
| 2017 December | 13 | 1 | 14 |
| 2017 November | 16 | 1 | 17 |
| 2017 October | 12 | 1 | 13 |
| 2017 September | 22 | 2 | 24 |
| 2017 August | 5 | 0 | 5 |
| 2017 July | 4 | 2 | 6 |
| 2017 June | 0 | 1 | 1 |
| 2017 February | 17 | 6 | 23 |
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