Bacteremia Caused by Microbacterium binotii in a Patient with Sickle Cell Anemia

Abstract

cMicrobacterium species are non-spore-forming, Gram-positive rods rarely associated with human disease. In this report, we describe the first case of bacteremia caused by Microbacterium binotii in a patient with sickle cell anemia. The utility of using 16S rRNA gene sequence analysis along with phenotypic methods for identification is shown. CASE REPORTA 28-year-old male presented to the emergency department (ED) complaining of fever, fatigue, nausea, and nasal congestion. The patient had a history of sickle cell anemia with recurrent pain crises and narcotic dependence. He reported no other localizing symptoms of infections, admitted no exposures to others who were ill, and had no indwelling lines or hardware.On physical exam, the patient was febrile (38.4°C/101.2°F) with no other signs of sepsis. Hematological testing revealed leukocytosis, microcytic anemia, and mild thrombocytosis, which were relatively unchanged from prior labs. A urinalysis and chest X-ray were unremarkable. Two sets of blood cultures (BD Bactec; Becton, Dickinson and Co., Sparks, MD) were collected peripherally, and the patient was discharged from the ED with a presumed viral illness. Subsequently, both aerobic blood culture bottles grew small, Gram-positive rods after 43 h of incubation. The patient was asked to return to the hospital for a follow-up evaluation and treatment.Upon readmission, the patient appeared nontoxic with a lowgrade fever (38.0°C/100.4°F). Again, no localizing signs of infection were found, and repeat labs revealed near resolution of leukocytosis. Two sets of additional blood cultures were drawn prior to empirical administration of intravenous (i.v.) piperacillin-tazobactam (4,500 mg, once) and vancomycin (15 mg/kg of body weight, then 1,000 mg every 8 h). The patient rapidly defervesced following antibiotic therapy, with one repeat aerobic blood culture bottle growing Gram-positive rods after 67 h of incubation.All three positive blood culture bottles produced nonhemolytic colonies about 1 mm in size after subculture to 5% sheep blood agar and overnight incubation at 37°C in ambient air. The isolates were catalase positive and oxidase negative and developed a light-yellow pigment that became more intense over time. Using the RapID CB Plus system (Remel, Lenexa, KS), the isolates produced a microcode of 3755513, which yielded a probability of 99.66% for Oerskovia spp. and 0.34% for Microbacterium spp. Consequently, the isolates were reported as "most closely resembles Oerskovia species." Antimicrobial MICs were determined using Etest strips (bioMérieux, Durham, NC) and Mueller-Hinton agar containing 5% sheep blood (Remel, Lenexa, KS). Interpretations were based on the criteria for coryneform bacteria found in the CLSI document M45-A2 (1). The isolate was susceptible to linezolid (0.5 g/ml) and vancomycin (0.5 g/ml) and nonsusceptible to daptomycin (8.0 g/ml) (using Etest strips that contain a standard Ca 2ϩ overlay equivalent to 40 g/ml). Vancomycin was continued for 2 weeks, with repeat blood cultures drawn on day ...

Biliary microbiota and bile acids composition in cholelithiasis

“…It was found more abundant in fecal microbiome of biliary cirrhosis patients [25] and was isolated from bile samples of patients with acute cholecystitis [26] and liver abscesses [27]. Microbacterium genus abundance was associated with different inflammatory disorders: otitis externa [28], noma [29], and bacteremia [30]. OTUs belonging to [Tissierellaceae] family were more abundant in ulcerative colitis sites [31].…”

Scientific Opinion on the update of the list of QPS‐recommended biological agents intentionally added to food or feed as notified to EFSA†

“…In literature, no association of M. imperiale to pathology has been reported. In fact, out of the 84 species of the genus Microbacterium , only four have been described as involved in human pathological processes, the cases being extremely rare, occurring in patients with predisposing conditions and, in some cases, being part of a polymicrobial infection (Alonso‐Echanove et al., ; Giammanco et al., ; Adames et al., ; Enoch et al., ; Buss et al., ). The frequent need of a previous life‐threatening or immunodeficiency condition for successful Microbacterium spp.…”

“…infection may indicate that no significant virulence factors are produced by the species of this genus. Finally, resistance to chemotherapy appears to be scarce, with an almost universal susceptibility to β‐lactam and glycopeptide antibiotics (Adames et al., ; Buss et al., ).…”

Statement on the update of the list of QPS‐recommended biological agents intentionally added to food or feed as notified to EFSA 1: Suitability of taxonomic units notified to EFSA until October 2014

“…In fact, out of the 84 species of the genus Microbacterium only four have been described as involved in human pathological processes, the cases being extremely rare, occurring in patients with predisposing conditions and, in some cases, being part of a polymicrobial infection (Alonso-Echanove et al, 2001; Giammanco et al, 2006;Adames et al, 2010;Enoch et al, 2011;Buss et al, 2014). The frequent need of a previous life-threatening or immunodeficiency condition for successful Microbacterium spp.…”

“…infection may indicate that no significant virulence factors are produced by the species of this genus. Finally, resistance to chemotherapy appears to be scarce, with an almost universal susceptibility to β-lactam and glycopeptide antibiotics (Adames et al, 2010;Buss et al, 2014).…”