Gordonia araii Infection Associated with an Orthopedic Device and Review of the Literature on Medical Device-Associated Gordonia Infections

Abstract

Gordonia infections in humans are rare and usually affect immunocompromised patients. We present the first case of Gordonia araii infection associated with a medical device in an immunocompetent patient. Sequencing was required for conclusive identification. We compared our case to the 16 Gordonia speciesassociated medical device infections reported to date. CASE REPORTA healthy 27-year-old male presented to the Surgical Unit at the Wright-Patterson Medical Center following a sports-related injury of the right anterior cruciate ligament (ACL) and a right medial meniscus tear. Orthopedic surgery attached a hamstring tendon autograft by using an ACL femoral fixation implant (Scandius), a bioabsorbable tapered screw, and a tibial sheath (Mitek Surgical). A vacuum-assisted closure device was placed in the wound for 4 weeks.Six weeks following the surgery, the patient complained of fever, knee pain, and knee swelling and received incision and drainage at the surgical site. Routine bacterial cultures on brain heart infusion agar with 5% sheep blood were negative. A vacuum-assisted closure device was again placed for 4 weeks following this procedure.He presented again, 10 weeks after the initial surgery, complaining of redness and swelling of the right knee, and was noted to have wound dehiscence at the surgical site. He received another incision and drainage. Routine bacterial cultures on brain heart infusion agar with 5% sheep blood were again negative.He presented a fourth time, 21 weeks after the initial repair, with discharge from two sinus tracts which exited near the surgical site. A magnetic resonance imaging study revealed an effusion, an intact ACL graft, and edema in both the tibia and the femur at the graft attachment site. He denied symptoms at any other site, and his peripheral white blood cell count was normal. He was taken to surgery, where the right knee was incised and drained. All foreign materials, including the bioabsorbable implant, were removed and sent for culture. Following surgery, the patient was placed on intravenous levofloxacin (500 mg daily) and intravenous vancomycin (1 g twice daily).On the basis of antimicrobial testing results obtained from the National Jewish Medical and Research Center (NJMRC), on day 16 of the fourth presentation, the patient was switched to intravenous trimethoprim-sulfamethoxazole (TMP-SMX; 175 mg to 875 mg) twice daily to complete a 31-day course of antibiotic treatment. The patient had a full recovery from both the infection and the knee surgery. Follow-up a year later and an inquiry 3 years later indicated no further problems.Laboratory analysis of joint fluid revealed a total white blood cell count of 4,750/mm 3 , with a differential of 36% segmented neutrophils, 53% lymphocytes, and 11% monocytes.Three days after the samples were cultured, light growth of gram-positive bacilli was noted to occur on a brain heart infusion agar plate with 5% sheep blood, from the bio-absorbable screw. After 11 days of incubation, heavy growth of grampositive bacilli was noted ...

Gordonia Species as Emerging Causes of Continuous-Ambulatory-Peritoneal-Dialysis-Related Peritonitis Identified by 16S rRNA and secA1 Gene Sequencing and Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry (MALDI-TOF MS)

“…In fact, two of the four patients in this study had broken Tenckhoff catheter tips 1 to 2 weeks prior to the development of peritonitis, which likely predisposed those patients to the entry of the Gordonia bacteria into the peritoneal cavities. Notably, Gordonia species have been most commonly reported to be causes of indwelling device-associated infections (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30), in line with these cases of Gordonia CAPD-related peritonitis.…”

Hickman catheter-related bacteremia caused by Gordonia sputi in a patient with breast cancer

“…Antimicrobial therapy with teicoplanin and carbapenem along with removal of the catheter was proven successful, although the catheter removal remains a controversial issue [9,12]. The primary care physicians, having oncology experience, had chosen this regimen based upon the MIC results of meropenem, as well as on previous successful clinical experiences using broader antimicrobial coverage when treating immunocompromised cancer patients.…”

“…These include cases of bacteremia, native valve endocarditis, sternal wound infections and mediastinitis after coronary artery bybass, brain abscess, lung and pleural fluid infection, skin infection with lymphadenitis, granulomatous mastitis, mycetoma, keratitis, conjunctivitis and medical device associated septic arthritis [4,5,[8][9][10][11]. Most case reports of Gordonia infection in both adults [9] and children [12] have involved patients with immune dysfunction, mainly suffering from malignant diseases as indicated in the present case.…”

“…A review of reported cases of Gordonia species BSI showed a high cure rate, suggesting low virulence of this genus [4,5,[8][9][10][11][12]. However, the slow growth of Gordonia species in the culture media (more than 48 hours) in combination with the often inconclusive results by routine biochemical identification tests may contribute to an underestimation of its pathogenic role [11].…”

Gordonia Bacteremia

“…araii and G. effusa were first isolated from the sputum of a Japanese patient (11). G. araii has also been associated with orthopedic device infection (12).…”