Dialysis catheter related bacteriemia by Gordonia rubropertincta and Sputi in two hemodialysis patients
Bacteriemia relacionada por Gordonia rubropertincta y Sputi en 2 pacientes en hemodiálisis
Here we present two cases of bacteremia related to catheter infection by this organism.
Patient 1: 85-year-old man with end-stage renal disease on hemodyalisis via permanent tunelled catheter, was hospitalised in Nephrology for study something similar than a constitutional syndrome. He related a period of two months characterised by weakness, fever lower than 38°C without shivering, and hyporexia with a lost of 10kg.
The blood test showed leukocytosis (10,850/>L, normal formula), hemoglobin 12.1g/dL, C-reactive protein 10mg/L. The rest of analyzed parameters were normal range. Other studies, including blood cultures, tumor markers and computed topographies, were conducted without any positive result.
As the patient remained with fever, daptomycin and meropenem were initiated. After 8 days of empiric antibiotic treatment, blood cultures revealed a gram positive bacillus, which was finally identified as a Gordonia rubropertincta. Meropenem was stopped after a 14-day treatment, and at the time of the discharge medical, the patient was completely asymptomatic, and blood cultures were negative.
Two weeks later, the patient came back with the same symptoms, and new blood cultures revealed G. rubropertincta again. Meronem was administrated, and then, the tunneled catheter was removed.
Although cultures drawn from the dialysis catheter were all negative, antibiotic treatment was given for 3 weeks more and a transesophageal echocardiography was performed being negative for endocarditis.
Patient 2: A 91-year- old man, on hemodyalisis via permanent tunelled catheter, presented well-tolerated fever intradialysis with no other symptoms associated. Blood test showed leukocytes 5890 (neutrophils 79.85) and PCR 1, with the remaining results normal.
Empiric antibiotic treatment with vancomycin was initiated, and blood cultures isolated Gordonia sputi. After 3 weeks treatment, the patient was asymptomatic, but a new control blood culture revealed G. sputi again. Then, we administrated ciprofloxacin and the tunneled catheter was removed. The last blood sample test was negative.
This is the first report of catheter related bacteraemia caused by G. rubropertincta and Sputti, confirming its pathogenic potential in dialysis patients.
Gordonia species are aerobic actinomycetes, Gram-positive, catalase-positive and weakly acid-fast bacilli.1 They are isolated from the environment, useful properties in biotechnology, but they also have been reported to cause infections. Their identification by conventional methods is difficult, so it is believed that a number of Gordonia spp. infections are undetected.2 Recently, Ramanan et al. reported 5 cases of Gordonia bacteremia colleted between 1999 and 2013. In three cases the infection was related to a Hickman catheter, and another was considered a contamination from a tunneled dialysis catheter. Interestingly, none of these species were G. rubropertincta, and in addition, the infection in the hemodialysis patient was considered as a contaminant.3
Our case report other specie, G. rubropertincta, that was previously known as Rhodoccoccus rubropertinctus until 1989. It is a rare pathogen that could cause a variety of infections in humans, not only immunocompromised even immunocompetent hosts.3,4
Although there is no standardized treatment due to the small number of cases reported, it seems that Gordonia spp. is usually susceptible to several antibiotic treatments, and it has good response rates. In our case, antibiotic treatment with daptomycin and meropenem was not enough even long-term, and removing the intravascular catheter was needed to get negative blood cultures.
In conclusion, improvement in laboratory techniques will allow identifying ubiquitous microorganisms as Gordonia spp., whom must be taken into account as responsible of infections in patients with hemodialysis catheters. To ensure the eradication of these microorganism, it would be advisable to remove the intravascular dispositive