A case of diabetic foot ulcers complicated by severe infection and sepsis with Trueperella bernardiae

Abstract

Introduction: Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) allows us to identify bacteria directly from positive blood cultures with detailed taxonomy naming of the bacterial strains. Knowing the name of the infective bacteria makes it possible to adjust the antibiotic therapy early on. However, it also gives rise to detection of a number of unusual pathogens, which raises new questions on the pathogenicity and medical importance of a number of rarely isolated bacteria such as Trueperella bernardiae.Case presentation: We describe a case of diabetic foot ulcers in a 45-year-old male, which led to below-the-knee amputation due to widespread infection and sepsis with T. bernardiae and coinfection with Peptoniphilus lacrimalis. The patient was treated initially with surgical debridement in combination with piperacillin/tazobactam and thereafter with amoxicillin for a total period of 1 month.Conclusion: Based on this case, as well as previous case reports in the literature, we conclude that T. bernardiae is a rarely isolated low-pathogenic bacterium in patients with severe comorbidities. Often co-infection with other low-pathogenic bacteria is observed. T. bernardiae is susceptible to and readily treated with b-lactam antibiotics.

Trueperella bernardiae: first report of wound infection post laparoscopic surgery

“…This result differs from the findings of other studies, in which all samples from Canada, USA, and Switzerland were susceptible to all antimicrobial drugs except ciprofloxacin [3]. The bacterium was susceptible to erythromycin, piperacillin/tazobactam, linezolid, moxifloxacin, and rifampicin and resistant to norfloxacin and fosfomycin in previous studies [5,12]. There are also reports of different MIC values for penicillin in previous studies (e.g., ≤0.03 lg/mL [3], 0.016 lg/mL [5], 0.25 lg/mL [12], and 0.064 lg/mL in our study).…”

“…The bacterium was susceptible to erythromycin, piperacillin/tazobactam, linezolid, moxifloxacin, and rifampicin and resistant to norfloxacin and fosfomycin in previous studies [5,12]. There are also reports of different MIC values for penicillin in previous studies (e.g., ≤0.03 lg/mL [3], 0.016 lg/mL [5], 0.25 lg/mL [12], and 0.064 lg/mL in our study).…”

“…After laboratory confirmation of the presence of Trueperella bernardiae, we suggested narrowing the antibiotic spectrum to penicillin or amoxicillin but the suggestion was refused and the treatment was de-escalated to oral amoxicillin/clavulanate, which resulted in a favorable clinical outcome. Otto et al [5] also successfully used amoxicillin/clavulanate as a directed therapy, while Schneider et al [12] used amoxicillin isolatedly.…”

“…Trueperella bernardiae was previously identified from blood culture, abscesses, and eye infections [3]. There are case reports of severe urinary tract infections complicated by septicemia [6], septic arthritis [7], coinfection with Staphylococcus aureus from chronic osteitis [8], prosthetic joint infection [9], necrotizing fasciitis [10], bacteremia secondary to soft tissue infection [11], bacteremia due to chronic ulcers of the lower limbs [5], diabetic foot infection, and sepsis [12].…”

Trueperella bernardiae: an unusual cause of septic thrombophlebitis in an injection drug user

“…It also illustrates the invasive potential of the bacterium, albeit in a patient with increased susceptibility to bloodstream infection due to injection drug use. In the literature, we only found four previous reports of bacteraemia due to this organism [2] , [3] , [4] , [5] , with several other reports describing septic arthritis and brain abscess [4] , [6] , [7] , [8] , [9] .…”