Gordonia sputi -associated bloodstream infection in a renal transplant patient with chronic indwelling central venous catheter: a case report and literature review

Abstract

Introduction: Although rare, human infections caused by Gordonia spp. have been reported especially within the immunocompromised population and those with long-term indwelling devices. We report a case of Gordonia spp. bacteremia in a renal transplant patient and present a literature review on microbiologic identification methods of this organism. Case Presentation: A 62-year-old female renal transplant recipient admitted to hospital with a 2-month history of dry cough and fevers occurring weekly when receiving electrolyte replacement infusions via Groshong line. Over two weeks, blood cultures on multiple occasions repeatedly isolated a Gram-positive bacillus in aerobic bottle only, initially reported as Rhodococcus spp. by local microbiology laboratory. Chest computed tomography (CT) showed multiple ground-glass lung opacities suggestive of septic pulmonary emboli. As central line-associated blood stream infection was suspected, empiric antibiotics were initiated and the Groshong line was removed. The Gram-positive bacillus was later confirmed by reference laboratory as Gordonia sputi via 16S-rRNA sequencing. Vancomycin and ciprofloxacin for duration of six weeks was completed as targeted antimicrobial therapy. After treatment, she remained symptom-free with marked improvement on repeat CT chest imaging. Conclusion: This case illustrates the challenges surrounding identification of Gordonia spp. and other aerobic actinomycetes.16S-rRNA gene sequencing may be a preferred identification method, especially when initial workup of a weakly acid-fast organism fails to identify or shows discrepant results using traditional diagnostic modalities.