Polymicrobial Bloodstream Infection with Eggerthella lenta and Desulfovibrio desulfuricans

Abstract

The advancement in culture identification methods has made possible the culture and identification of slow-growing anaerobic bacteria in clinical samples. Here, we describe a case of polymicrobial bloodstream infection (BSI) caused by Eggerthella lenta and Desulfovibrio desulfuricans, identified by API 20A and Vitek 2 systems and by 16S rRNA sequencing. CASE REPORTThe patient was an 86-year-old woman, living alone though provided with community home care assistance. In spring of 2009, the patient was admitted to hospital twice. The first time, she presented with dyspnea, an obstructive breathing pattern, confusion, and a high fever. She was admitted to a geriatric hospital where she stayed for 2 weeks and was initially treated with trimethoprim-sulfamethoxazole. Treatment was switched to cefuroxime after 3 days due to treatment failure, and the course was finished with amoxicillin. One week after getting discharged from the geriatric hospital, she was admitted to Stockholm South General Hospital. She presented with a fever, dyspnea, and this time with diarrhea as well. Upon examination, a decubital wound, not described earlier, which was 4 by 3 cm wide and 1 cm deep, was found in the sacrum area. She had a temperature of 39.3°C, a heart rate of 104 beats/minute, a blood pressure of 106/54 mm Hg, and a breathing frequency of 35 breaths/minute. Her white cell count at admission was 20 ϫ 10 9 /liter, and her C-reactive protein level was 104 mg/liter. Initially, the clinical picture together with the laboratory results was interpreted as a bloodstream infection (BSI) derived from an airway infection. However, the wound found in the sacrum, which appeared infected, was considered an alternative source for the infection. Cultures were taken from the blood, the nasopharynx, and the decubital wound. Growth was reported to occur in one blood culture vial on day 3. The nasopharynx culture showed no pathogenic bacteria, and the wound culture showed mixed bacterial flora containing several different types of Enterobacteriaceae. The antibiotic treatment was started with cefuroxime and then switched to amoxicillin after 2 days. The patient was discharged when both the clinical and the laboratory parameters, including C-reactive protein level and white cell count, were normalized after antibiotic treatment.Blood samples were cultured in a BacT/Alert 3D (bioMérieux, Inc., Durham, NC) automated blood culture system. After 52 h of incubation, one of two anaerobic blood culture vials signaled positive. Gram staining revealed Gram-positive bacilli. Broth from the anaerobic bottle was subcultured onto blood agar plates incubated in air, chocolate agar plates were incubated in 5% CO 2 , and blood agar plates were incubated in an anaerobic jar. After 48 h of incubation at 37°C, no growth was seen on the plates incubated in air and in those incubated in CO 2 . A tiny growth was seen in the plates incubated in the anaerobic jar, which was inhibited by a metronidazole disc (Oxoid, Ltd., Basingstoke, Hampshire, United Kingdom). The plate ...

Influence of microflora composition on safety and colour parameters of “kumpia wieprzowa” during ripening

“…According to Takahashi and Yamada (1999), Ezaki et al (2001), Lavigne et al (2003), Finegold et al (2005), López-Enrtquez et al (2007), Fiorentini et al (2009), Labutti et al (2009 and Liderot et al (2010) the isolated microorganisms originated from animal/human skin, intestines, and tissues as well as from herbal additives, and the pigsty and manufacturing environment also constituted a specific part of the "kumpia wieprzowa house microflora". Their presence indicated the capacity for fresh meat contamination during the initial post-slaughter treatment (scalding, bleeding, skinning or evisceration as well as during technological treatment (trimming, salting, hanging, smoking, weighing).…”

Eggerthella lentaBacteremia after Endoscopic Retrograde Cholangiopancreatography in an End-Stage Renal Disease Patient

“…And E. lenta bacteremia is considered to be more than identified because of its difficulties of identification [2,8]. But in the case of E. lenta from VITEK 2, we think that confirmation by 16S rRNA sequencing may not be needed in consideration of latest reports including our case [4,6,9]. E. lenta was isolated from feces primarily and known as gut commensals.…”

“…Because of this limitations, 16S rRNA sequencing is thought as a good choice for a diagnostic tool to confirm E. lenta infections [2,6,8]. And E. lenta bacteremia is considered to be more than identified because of its difficulties of identification [2,8].…”

“…Especially in patients with predisposing factors, bacteremia is associated with high mortality [3,6,7,14].…”

“…A few studies reported the susceptibilities of E. lenta [3,6,7,15]. In the article by Mosca et al, including 29 strains of E. lenta clinical isolated, all were susceptible to clindamycin, piperacillin and imipenem [15].…”