Letter to the Editor
Persistent bacteremia by Tsukamurella paurometabola secondary to placement of peripheral insertion central catheter
Bacteriemia persistente por Tsukamurella paurometabola secundaria a colocación de catéter central de inserción periférica
Laura Rodríguez Fernández
, Miguel Martín Asenjo, Carlos Jesús Dueñas Gutiérrez
Corresponding author
Servicio de Medicina Interna, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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There are other genera closely related to these species: <span class="elsevierStyleItalic">Nocardia</span>, <span class="elsevierStyleItalic">Corynebacterium</span>, <span class="elsevierStyleItalic">Rhodococcus</span>, <span class="elsevierStyleItalic">Gordonia</span>, <span class="elsevierStyleItalic">Streptomyces</span> and <span class="elsevierStyleItalic">Mycobacterium</span>, which explains its frequent misidentification. <span class="elsevierStyleItalic">Tsukamurella</span> spp. are common saprophytes found mainly in the soil, sludge and arthropods, and can become opportunistic pathogens.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present the case of a 37-year-old man allergic to penicillins and cephalosporins, a habitual consumer of alcohol and cannabis, with an 18-year personal history of arterial hypertension with poor therapeutic compliance, and chronic kidney disease with left intravenous humerocephalic fistula on hemodialysis for the past 6 years due to nephroangiosclerosis. The patient was admitted for programmed parathyroidectomy secondary to hyperplasia and lower left parathyroid adenoma. During admission, a peripherally inserted central catheter (PICC) line was inserted due to poor venous access. A week later the patient began with a fever of up to 39 °C and shivering, and with an increase in the acute phase reactant - procalcitonin 9.21 ng/mL (normal value < 0.5 ng/mL). Blood cultures were positive for <span class="elsevierStyleItalic">Tsukamurella paurometabola</span>. The PICC line was withdrawn and antibiotic therapy with levofloxacin and gentamicin was started. Low-grade fever persisted and serial blood cultures were positive so doxycycline was added. As the need for intravenous calcium replacement was important, a right jugular central catheter was inserted. At 48 hours the fever reappeared, with new central and peripheral blood cultures being positive for <span class="elsevierStyleItalic">T. paurometabola.</span> Therefore, after ruling out other infectious foci, the regimen was modified to ciprofloxacin, daptomycin, doxycycline and clarithromycin adjusted to the renal function, and the central line was withdrawn. The patient evolved favorably, remaining afebrile and with subsequent negative blood cultures after 2 more weeks of antibiotic therapy.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The genus <span class="elsevierStyleItalic">Tsukamurella</span> currently contains 17 species with published names.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> To date, nine species have been isolated from humans: <span class="elsevierStyleItalic">inchonensis</span>, <span class="elsevierStyleItalic">paurometabola</span>, <span class="elsevierStyleItalic">strandjordii</span>, <span class="elsevierStyleItalic">tyrosinosolvens</span>, <span class="elsevierStyleItalic">pulmonis</span>, <span class="elsevierStyleItalic">hongkongensis</span> and <span class="elsevierStyleItalic">sinensis,</span> with the most recent being <span class="elsevierStyleItalic">ocularis and hominis</span>.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The most common foci of infection are: bacteremia, meningitis, peritonitis, keratitis, skin infection, conjunctivitis, brain abscess, respiratory tract infection and acute otitis media.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Regarding <span class="elsevierStyleItalic">T. paurometabola</span>, it rarely causes infections. Only 4 cases have been reported: one case of bacteremia in a patient undergoing hemodialysis with a Sorenson catheter and 3 cases in neutropenic patients with underlying malignancies and indwelling catheters.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> These infections are related to foreign bodies, immunosuppression or hemodialysis replacement therapy. There is little data published about the most appropriate treatment. These strains are typically resistant to penicillin, oxacillin, piperacillin–tazobactan and cephalosporins,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> but susceptible to amikacin, ciprofloxacin, imipenem, doxycycline, linezolid and sulfamethoxazole.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Due to the few cases described, it is advisable to combine antibiotics and remove the vascular catheters promptly.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Given the scarce and dated therapeutic experience available, we believe that, in the face of severe infections, the implantation of combined antibiotic therapy, at least until negative cultures, together with the removal of the catheter, is the most effective option. However, the insufficient data recorded on its treatment means that more research is required to improve the clinical and therapeutic perspectives.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Rodríguez Fernández L, Martín Asenjo M, Dueñas Gutiérrez CJ. Bacteriemia persistente por <span class="elsevierStyleItalic">Tsukamurella paurometabola</span> secundaria a colocación de catéter central de inserción periférica. Med Clin (Barc). 2020;155:515–516.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Central venous catheter-related bacteremia due to <span class="elsevierStyleItalic">Tsukamurella</span> species in the immunocompromised host: a case series and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. Schwartz" 1 => "S.R. Tabet" 2 => "A.C. Collier" 3 => "C.K. Wallis" 4 => "L.C. Carlson" 5 => "T.T. 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