These results suggest that the saponin method is superior to the centrifugation method and comparable to the Sepsityper method in the accuracy of rapid bacterial identification directly from blood culture bottles, and could be a less expensive alternative to the Sepsityper method.

Mycobacterium kyorinense sp. nov., a novel, slow-growing species, related to Mycobacterium celatum, isolated from human clinical specimens A novel, non-pigmented, slow-growing mycobacterium was identified on the basis of biochemical and nucleic acid analyses, as well as growth characteristics. Three isolates were cultured from clinical samples (two from sputum and one from pus in lymph nodes) obtained from three immunocompetent patients with infections. Bacterial growth occurred at 28-42 6C on Middlebrook 7H11-OADC agar. The isolates showed negative results for Tween hydrolysis, nitrate reductase, semiquantitative catalase, urease activity, 3 day arylsulfatase activity, pyrazinamidase, tellurite reduction and niacin accumulation tests, but positive results for 14 day arylsulfatase activity and heat-stable catalase tests. The isolates contained a-, keto-, and dicarboxymycolates in their cell walls. Sequence analysis revealed that all isolates had identical, unique 16S rRNA sequences. Phylogenetic analysis of the 16S rRNA, rpoB, hsp65 and sodA gene sequences confirmed that these isolates are unique but closely related to Mycobacterium celatum. DNA-DNA hybridization of the isolates demonstrated less than 50 % reassociation with M. celatum and Mycobacterium branderi. On the basis of these findings, a novel species designated Mycobacterium kyorinense sp. nov. is proposed. The type strain is KUM 060204 T (5JCM 15038 T 5DSM 45166 T ).The GenBank/EMBL/DDBJ accession numbers for the 16S rRNA, hsp65, proB and sodA gene sequences of strains KUM 060204 T , NTH 512-121 and AHM 060905 are, respectively: AB370111, AB370169 and AB370170 (16S rRNA); AB370171, AB370176, and AB370177 (hsp65); AB370178, AB370182, and AB370183 (rpoB); AB370184, AB370188, and AB370189 (sodA).

c Candida glabrata strains sequentially isolated from blood developed resistance to micafungin (MICs from <0.015 to 4 g/ml). A novel mutation identified in micafungin-resistant strains at bp 262 of FKS2 (containing a deletion of F659 [F659del]) was inserted into the homologous region in FKS1. CASE REPORTA 93-year-old man was admitted to our hospital with a diagnosis of pulmonary tuberculosis (day 1). The patient had been receiving treatment for essential hypertension with chronic renal failure for a decade. On admission, the patient's vital signs were normal; however, serum laboratory data showed a marked elevation of creatinine (Cr) (4.7 mg/dl) and blood urea nitrogen (BUN) (74.5 mg/dl). After initiation of antituberculous therapy with oral isoniazid (300 mg/day) plus rifampin (450 mg/day), renal failure progressed (Cr, 7.0 mg/dl) due to drug-induced myoglobinemia (1,000 ng/ml) with uremic symptoms. Although an urgent flexible double lumen (FDL) catheter was introduced into the internal jugular vein, readministration of isoniazid (day 18) caused severe rhabdomyolysis (myoglobinemia, 25,650 ng/ml), with a recurrence of the uremic symptoms.On day 27, the patient suddenly went into a state of shock with high fever and was empirically treated with intravenous meropenem (0.5 g/day), vancomycin (0.5 g, every 48 h [q48h]), and fluconazole (200 mg/day) based on a tentative diagnosis of aspiration pneumonia or catheter-related bloodstream infection complicated by sepsis. On the same day, two sets of blood cultures and serum endotoxin antigen were negative except for an elevation of ␤-D-glucan (133 pg/ml). On day 32, the patient's serum value of ␤-D-glucan rose to 530 pg/ml, and he had a positive result for serum galactomannan (Aspergillus antigen) of 4.5, thrombocytopenia (6.4 ϫ 10 3 platelets/l), and leukocytopenia (2.0 ϫ 10 3 leukocytes/l). Therefore, the fluconazole was changed to voriconazole (6 mg/kg of body weight/day, q12h) with the intent of targeting Aspergillus spp. However, on day 35, a blood culture collected on day 32 (strain NO1) was identified as Candida glabrata; therefore, voriconazole was changed to intravenous micafungin (100 mg/day) according to the Infectious Diseases Society of America (IDSA) 2009 guidelines (1). A blood culture taken on day 34 (NO2) also was positive for C. glabrata; however, after initiation of treatment with micafungin, the persistent fever subsided, and a blood culture taken at day 37 was negative for the yeast. Both strain NO1 and strain NO2 were susceptible to micafungin (MIC, Ͻ0.015 g/ml) but susceptible-dose dependent to fluconazole (MIC Ͻ8 g/ml) by Clinical and Laboratory Standards Institute (CLSI) broth microdilution (BMD) methods (CLSI document M27-S4). With regard to voriconazole, no breakpoint was determined for C. glabrata. In spite of two rounds of replacement of the FDL catheter, the serum value of ␤-D-glucan remained high (Ͼ600 pg/ml), and blood cultures taken on day 48 (NO3) and day 51 (NO4) again yielded C. glabrata. Based on the suspicion of a micafungin-resista...

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