Scientific letter
Pseudomonas monteilii nosocomial meningitis in a patient with an intraventricular catheter
Meningitis nosocomial por Pseudomonas monteilii en paciente portador de catéter intraventricular
Héctor Toledo, Guillermo Martín-Gutiérrez
, José Antonio Lepe
Corresponding author
Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P. monteilii</span> colonies cultured on Columbia agar under aerobic conditions for 24 h. Colonies are white, shiny and mucoid.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 78-year-old male was admitted to our hospital with an extra-axial space-occupying lesion suggestive of posterior fossa meningioma, which was later confirmed by nuclear magnetic resonance. Surgery was performed to remove the meningioma and to insert an external ventricular drain to remove excess cerebrospinal fluid (CSF) due to developing secondary hydrocephalus, with subsequent admission to the intensive care unit (ICU).</p><p id="par0010" class="elsevierStylePara elsevierViewall">On day 13 in the ICU, the device was changed after the first device malfunctioned due to the presence of a clot blocking the ventricular portion of the catheter. On day 26, the patient experienced an accelerated decline in neurological function with a blood-like fluid observed in the drain, which was sent for microbiological study. Empirical antibiotic therapy was initiated with meropenem and linezolid.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Biochemistry testing of the fluid suggested a bacterial infection due to the presence of pleocytosis (1320 cells/ml), with 90% polymorphonuclear lymphocytes, low glucose levels (0.2 g/l) and high protein (1.5 g/l) and lactic acid (1.1 g/dl) levels.</p><p id="par0020" class="elsevierStylePara elsevierViewall">A gram stain showed abundant polymorphonuclear leukocytes and gram-negative rods of variable length with no specific morphology. In view of these findings, it was decided to perform a molecular study using multiplex PCR (FilmArray®, BCID panel, bioMérieux), based on the recommendations of Micó et al.,<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which was negative. Subsequently, a sample was cultured on blood agar, MacConkey agar and chocolate agar and incubated at 37 °<span class="elsevierStyleSmallCaps">C</span> in aerobic conditions and 5% CO<span class="elsevierStyleInf">2</span>, respectively.</p><p id="par0025" class="elsevierStylePara elsevierViewall">After 18 hours, growth in pure culture of non-pigmented mucoid colonies was observed on all three media (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The oxidase test was positive. The isolate was identified as <span class="elsevierStyleItalic">Pseudomonas fluorescens</span>/<span class="elsevierStyleItalic">putida</span> (99.9% probability) using a MicroScan Combo Panel, Type 71 (Beckman-Coulter, USA). It demonstrated sensitivity to standard doses of: meropenem, amikacin, tobramycin and colistin, and sensitivity with increased exposure to: piperacillin, ceftazidime, cefepime, ciprofloxacin and imipenem, based on EUCAST criteria.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Duplicate mass spectrometry (Microflex LT, Bruker Daltonics, USA) identified the isolate as <span class="elsevierStyleItalic">Pseudomonas monteilii</span>, with values of 2.25 and 2.10 using matrix only and values of 2.34 and 2.19 with pre-treatment with formic acid.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The final diagnosis was meningoencephalitis caused by <span class="elsevierStyleItalic">P. monteilii</span> as a result of infection of the drainage device and treatment was changed to ceftazidime, resulting in a rapid clinical improvement, which was confirmed by negative CSF culture results at 72 h.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The genus <span class="elsevierStyleItalic">Pseudomonas</span> is divided into three phylogenetic lineages and at least 19 groups and sub-groups. One of the most relevant groups is the <span class="elsevierStyleItalic">Pseudomonas putida</span> group, which comprises up to 15 strains, including <span class="elsevierStyleItalic">P. monteilii</span>,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which was first described in 1997.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Phenotypically it easily fits into this group based on Pickett’s and Gilardi’s identification schemes,<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5,6</span></a> falling into the fluorescent group of non-fermenting gram-negative bacilli (GNB), together with <span class="elsevierStyleItalic">Pseudomonas aeruginosa</span> and <span class="elsevierStyleItalic">Pseudomonas fluorescens</span>. This phenotypic characterisation is still valid, despite the reclassification of <span class="elsevierStyleItalic">Pseudomonas</span> based on RNA/DNA homology studies and 16S rRNA gene sequencing-based characterisation.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Also, per routine clinical laboratory practices, <span class="elsevierStyleItalic">P. monteilii</span> can be quickly and safely identified using mass spectrometry.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P. monteilii</span> is an environmental microorganism in healthcare settings and is often isolated from sink, tap and shower surfaces.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> In this context, it must also be considered as a potential pathogen and, as such, it has also been cultured from clinical specimens such as bronchial aspirates, urine, stool, bile and blood.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Nevertheless, its role as a cause of central nervous system (CNS) infections has been rarely reported. In addition, evidence of infection is not clearly demonstrated in many of the cases described and this could suggest that <span class="elsevierStyleItalic">P. monteilii</span> may have low pathogenicity, act as a coloniser and only be a source of infection in critically ill or immunocompromised patients or those who have biomedical devices.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conclusions</span><p id="par0045" class="elsevierStylePara elsevierViewall">Based on the above, the growth of <span class="elsevierStyleItalic">P. monteilii</span> on culture media was associated with a nosocomial infection of the external drain valve, either due to colonisation from the patient’s skin or handling of the device by healthcare staff, with this acting as a portal of entry for this microorganism into the ventricular fluid.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0050" class="elsevierStylePara elsevierViewall">Guillermo Martín Gutiérrez has a Juan Rodés clinical research contract (JR19/00039) from <span class="elsevierStyleGrantSponsor" id="gs0005">Instituto de Salud Carlos III, Ministry of Economy and Competitiveness (Ministerio de Economía y Competitividad)</span>, and also an Action B - Clinical Researchers (Acción B Clínicos Investigadores) contract (B-0006-2019) for promoting research activities within Clinical Management Units of the Andalucian Health Service (Servicio Andaluz de Salud) 2019, Department of Health and Families (Consejería de Salud y Familias).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflicts of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conclusions" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Funding" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflicts of interest" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Toledo H, Martín-Gutiérrez G, Lepe JA. Meningitis nosocomial por <span class="elsevierStyleItalic">Pseudomonas monteilii</span> en paciente portador de catéter intraventricular. Enferm Infecc Microbiol Clin. 2022;40:92–93.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1118 "Ancho" => 1674 "Tamanyo" => 209435 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">P. monteilii</span> colonies cultured on Columbia agar under aerobic conditions for 24 h. Colonies are white, shiny and mucoid.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of the filmarray blood culture identification panel for direct molecular diagnosis of infectious diseases from samples other than blood" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. Micó" 1 => "F. Navarro" 2 => "D. de Miniac" 3 => "Y. González" 4 => "A. Brell" 5 => "C. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 26 | 2 | 28 |
| 2024 September | 85 | 4 | 89 |
| 2024 August | 59 | 1 | 60 |
| 2024 July | 49 | 6 | 55 |
| 2024 June | 40 | 3 | 43 |
| 2024 May | 32 | 3 | 35 |
| 2024 April | 21 | 2 | 23 |
| 2024 March | 33 | 4 | 37 |
| 2024 February | 74 | 3 | 77 |
| 2024 January | 58 | 4 | 62 |
| 2023 December | 56 | 7 | 63 |
| 2023 November | 55 | 5 | 60 |
| 2023 October | 87 | 9 | 96 |
| 2023 September | 37 | 6 | 43 |
| 2023 August | 49 | 1 | 50 |
| 2023 July | 61 | 4 | 65 |
| 2023 June | 49 | 2 | 51 |
| 2023 May | 65 | 4 | 69 |
| 2023 April | 53 | 0 | 53 |
| 2023 March | 52 | 4 | 56 |
| 2023 February | 16 | 7 | 23 |
| 2023 January | 12 | 3 | 15 |
| 2022 December | 12 | 4 | 16 |
| 2022 November | 30 | 9 | 39 |
| 2022 October | 17 | 7 | 24 |
| 2022 September | 15 | 26 | 41 |
| 2022 August | 16 | 11 | 27 |
| 2022 March | 1 | 0 | 1 |
| 2022 February | 5 | 0 | 5 |
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