Letter to the Editor
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
Laura Salanova Villanueva
, Esther Ortega, Borja Quiroga
Corresponding author
Hospital la Princesa, Servicio de Nefrología, Madrid, Spain
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"Laura Salanova" "apellidos" => "Villanueva" "email" => array:1 [ 0 => "aelita.sv@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Esther" "apellidos" => "Ortega" ] 2 => array:2 [ "nombre" => "Borja" "apellidos" => "Quiroga" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Hospital la Princesa, Servicio de Nefrología, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bacteriemia relacionada por <span class="elsevierStyleItalic">Gordonia rubropertincta</span> y <span class="elsevierStyleItalic">Sputi</span> en 2 pacientes en hemodiálisis" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Here we present two cases of bacteremia related to catheter infection by this organism.</p><p id="par0010" class="elsevierStylePara elsevierViewall">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<span class="elsevierStyleHsp" style=""></span>°C without shivering, and hyporexia with a lost of 10<span class="elsevierStyleHsp" style=""></span>kg.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The blood test showed leukocytosis (10,850/>L, normal formula), hemoglobin 12.1<span class="elsevierStyleHsp" style=""></span>g/dL, C-reactive protein 10<span class="elsevierStyleHsp" style=""></span>mg/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.</p><p id="par0020" class="elsevierStylePara elsevierViewall">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 <span class="elsevierStyleItalic">Gordonia rubropertincta</span>. 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.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two weeks later, the patient came back with the same symptoms, and new blood cultures revealed <span class="elsevierStyleItalic">G. rubropertincta</span> again. Meronem was administrated, and then, the tunneled catheter was removed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">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.</p><p id="par0035" class="elsevierStylePara elsevierViewall">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.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Empiric antibiotic treatment with vancomycin was initiated, and blood cultures isolated <span class="elsevierStyleItalic">Gordonia sputi</span>. After 3 weeks treatment, the patient was asymptomatic, but a new control blood culture revealed <span class="elsevierStyleItalic">G. sputi</span> again. Then, we administrated ciprofloxacin and the tunneled catheter was removed. The last blood sample test was negative.</p><p id="par0045" class="elsevierStylePara elsevierViewall">This is the first report of catheter related bacteraemia caused by <span class="elsevierStyleItalic">G. rubropertincta</span> and <span class="elsevierStyleItalic">Sputti</span>, confirming its pathogenic potential in dialysis patients.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Gordonia species are aerobic actinomycetes, Gram-positive, catalase-positive and weakly acid-fast bacilli.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> 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 <span class="elsevierStyleItalic">Gordonia</span> spp. infections are undetected.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> 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 <span class="elsevierStyleItalic">G. rubropertincta</span>, and in addition, the infection in the hemodialysis patient was considered as a contaminant.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Our case report other specie, <span class="elsevierStyleItalic">G. rubropertincta</span>, that was previously known as <span class="elsevierStyleItalic">Rhodoccoccus rubropertinctus</span> until 1989. It is a rare pathogen that could cause a variety of infections in humans, not only immunocompromised even immunocompetent hosts.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Although there is no standardized treatment due to the small number of cases reported, it seems that <span class="elsevierStyleItalic">Gordonia</span> 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.</p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion, improvement in laboratory techniques will allow identifying ubiquitous microorganisms as <span class="elsevierStyleItalic">Gordonia</span> 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</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Involvement of two latex-clearing proteins during rubber degradation and insights into the subsequent degradation pathway revealed by the genome sequence of <span class="elsevierStyleItalic">Gordonia polyisoprenivorans</span> strain VH2" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Hiessl" 1 => "J. Schuldes" 2 => "A. Thürmer" 3 => "T. Halbsguth" 4 => "D. Bröker" 5 => "A. 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| 2017 August | 54 | 7 | 61 |
| 2017 July | 50 | 12 | 62 |
| 2017 June | 50 | 5 | 55 |
| 2017 May | 48 | 8 | 56 |
| 2017 April | 31 | 6 | 37 |
| 2017 March | 23 | 3 | 26 |
| 2017 February | 19 | 6 | 25 |
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