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xanthineolytica</span>&#41; and <span class="elsevierStyleItalic">Oerskovia turbata </span>&#40;<span class="elsevierStyleItalic">O&#46; turbata</span>&#41;&#44; which are currently known as <span class="elsevierStyleItalic">Cellulosimicrobium cellulans</span><span class="elsevierStyleSup">7</span> and <span class="elsevierStyleItalic">Cellulosimicrobium funkei&#44; </span>respectively&#44;<span class="elsevierStyleSup">8</span> according to comparative phylogenetic analysis based on 16S ribosomal rRNA gene sequences&#46; They are gram-positive bacilli found in the ground&#44; pastures and water from different parts of the world&#46; Colonies are characterised by a yellow pigment with branching vegetative hyphae which penetrate in the agar&#46;<span class="elsevierStyleSup">9&#44;10</span></p><p class="elsevierStylePara">Below&#44; we describe the first peritonitis case caused by <span class="elsevierStyleItalic">O&#46; turbata</span> in a patient undergoing automated peritoneal dialysis &#40;APD&#41;&#44; and have also reviewed published cases&#46;</p><p class="elsevierStylePara">We present the case of a 62-year-old man&#44; with a history of high blood pressure&#44; dyslipaemia&#44; stroke and ischaemic heart disease&#46; He started APD in August 2006 following bilateral kidney nephrectomy for transitional cell carcinoma&#46; He presented with his first <span class="elsevierStyleItalic">Pasteurella multocida</span> PI in October 2008&#44; which was presumably induced by contact with a cat&#46;</p><p class="elsevierStylePara">In July 2009&#44; he had his second PI&#46; He started drug treatment with vancomycin&#44; intraperitoneal gentamicin&#44; and ciprofloxacin orally&#46; On the third day&#44; gram-positive bacilli growth was found with a preliminary identification of O<span class="elsevierStyleItalic">erskovia </span>sp&#46; On the sixth day&#44; the antibiogram showed an intermediate sensitivity to ciprofloxacin and sensitivity to co-trimoxazole&#46; Ciprofloxacin was then replaced with oral co-trimoxazole&#44; intraperitoneal vancomycin regimen was continued every 5 days&#44; and gentamicin was withdrawn&#46; On the tenth day&#44; peritoneal fluid was clear&#46; Antibiotic treatment was maintained for 22 days&#46;</p><p class="elsevierStylePara">Thirteen days after finishing the antibiotic treatment&#44; the patient had a PI relapse&#46; Treatment using vancomycin&#44; intraperitoneal gentamicin and oral co-trimoxazole was restarted&#44; using fluconazole as prophylaxis&#46; On the third day&#44; fluid was clear and <span class="elsevierStyleItalic">Oerskovia </span>sp growth was resistant to co-trimoxazole&#44; and sensitive to ciprofloxacin&#46; The antibiotic regimen was therefore changed&#58; gentamicin was withdrawn and vancomycin maintained&#46; Twenty-one days after antibiotic treatment&#44; he had a second PI relapse&#46; The PD was removed and the patient was transferred to haemodialysis&#46; Catheter culture was negative&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Microbiology</span></p><p class="elsevierStylePara">The peritoneal fluids were collected in aerobic and anaerobic bottles for BacT&#47;Alert blood culture test &#40;bioM&#233;rieux&#44; Durham&#44; NC&#44; USA&#41;&#46; Both bottles were found to be positive at between 23 and 24 hours&#44; and the gram staining revealed branching gram-positive bacilli&#46; Chocolate agar&#44; blood agar&#44; and colistin-nalidixic acid &#40;CNA&#41; agar were reseeded on blood agar plates&#44; which were incubated at 35&#186;C in 5&#37; CO&#46; Some colony growth was observed at 48-72 hours&#46; It was the characteristic pastel yellow colour &#40;Figure 1&#41;&#46; The colonies were catalase-positive and oxidase-negative&#44; and were identified using API Coryne galleries &#40;bioM&#233;rieux&#44; Marcy L&#8217;&#201;toile&#44; France&#41;&#46; It had the code 7572727&#44; with an <span class="elsevierStyleItalic">Oerskovia </span>sp&#46; percentage of 99&#46;9&#37;&#46; Later&#44; we completed the 16S rRNA sequencing&#44; and the phylogenetic gene sequence analysis confirmed <span class="elsevierStyleItalic">Cellulosimicrobium funkei&#46;</span></p><p class="elsevierStylePara">&#160;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Review of the PI due to Oerskovia cases</span></p><p class="elsevierStylePara">We have found four cases of PI due to <span class="elsevierStyleItalic">O&#46; xanthineolytica </span>PD in the literature&#46; Catheter removal was necessary in two of these cases&#46;<span class="elsevierStyleSup">3&#44;6</span> Cases with good progress were treated with intraperitoneal antibiotics for 15 days<span class="elsevierStyleSup">4&#44;5 </span>&#40;Table 1&#41;&#46;</p><p class="elsevierStylePara">We would like to present the first PI due to <span class="elsevierStyleItalic">O&#46; turbata</span>&#46;<span class="elsevierStyleItalic"> </span>This species is less frequent in human infections than <span class="elsevierStyleItalic">O&#46; xanthineolytica </span>according to the review published in 2006&#46;<span class="elsevierStyleSup">7</span> This is the first case of infection caused by <span class="elsevierStyleItalic">Oerskovia</span> diagnosed in our health centre&#46; At present&#44; according to the comparative phylogenetic analysis based on 16S rRNA gene sequence&#44; it is called <span class="elsevierStyleItalic">Cellulosimicrobium&#46;</span></p><p class="elsevierStylePara">Human infections due to <span class="elsevierStyleItalic">Oerskovia </span>develop in immunosuppressed patients and foreign body carriers&#58; central catheters&#44; valvular and joint prostheses&#44; and peritoneal dialysis catheters&#46;<span class="elsevierStyleSup">3-7&#44;9&#44;11</span> In some cases&#44; the origin of the infection has been related to working or living in rural areas&#46;<span class="elsevierStyleSup">5&#44;10</span></p><p class="elsevierStylePara">More than one antibiotic may be necessary and the foreign body may need to be removed&#46; In all cases the germ has been sensitive to the antibiotic treatment in <span class="elsevierStyleItalic">in vitro</span> tests&#44; although <span class="elsevierStyleItalic">in vivo</span> results have been poor&#46;<span class="elsevierStyleSup">7</span> Our case&#44; despite correct antibiotic treatment&#44; did not manage to eradicate the infection and the PD catheter had to be removed&#46;</p><p class="elsevierStylePara">This bacterium is resistant&#44; although not especially virulent&#44; given that no deaths have been recorded&#46;<span class="elsevierStyleSup">7&#44;12</span> Most infections caused by <span class="elsevierStyleItalic">O&#46; turbata</span> have been in immunosuppressed patients&#46;<span class="elsevierStyleSup">13-15</span> Our patient lived in an urban area and had a pet cat&#44; but there are no references that show a relationship between infections caused by <span class="elsevierStyleItalic">Oerskovia</span> and domestic animals&#46;</p><p class="elsevierStylePara">The <span class="elsevierStyleItalic">Oerskovia </span>genus is often <span class="elsevierStyleItalic">in vitro </span>resistant to penicillin&#44; aminoglycosides&#44; macrolides and cephalosporins&#44; and intermediate resistance to ciprofloxacin&#46; It is considered <span class="elsevierStyleItalic">in vitro</span> sensitive to vancomycin and rifampicin&#46;<span class="elsevierStyleSup">7&#44;12</span> In this instance&#44; the germ was sensitive to vancomycin&#44; rifampicin&#44; meropenem and co-trimoxazole&#44; and was intermediate sensitive to ciprofloxacin&#46; Given that there are no standardised minimal inhibitory concentration &#40;MIC&#41; values to study the sensitivity of this bacterium&#44; we used the MIC for <span class="elsevierStyleItalic">Corynebacterium </span>sp&#46;</p><p class="elsevierStylePara">To conclude&#44; PIs caused by <span class="elsevierStyleItalic">Oerskovia</span> are rare despite it being a germ that is widely distributed in nature&#46; It can affect immunosuppressed patients and immunocompetent foreign body carriers&#46; Response to antibiotic treatment is often poor and catheter removal may be required&#46; This bacterium may be more common in humans in the future&#44; due to its distribution in nature&#44; and the increased number of immunosuppressed patients with prosthetic material&#46;</p><p class="elsevierStylePara"><a href="grande&#47;10508&#95;108&#95;15826&#95;en&#95;10508&#95;1&#46;jpg" class="elsevierStyleCrossRefs"><img src="10508_108_15826_en_10508_1.jpg" alt="Oerskovia culture on a blood agar plate"></img></a></p><p class="elsevierStylePara">Figure 1&#46; Oerskovia culture on a blood agar plate</p><p class="elsevierStylePara"><a href="grande&#47;10508&#95;108&#95;15827&#95;en&#95;t3&#95;carta&#46;jpg" class="elsevierStyleCrossRefs"><img src="10508_108_15827_en_t3_carta.jpg" alt="Review of cases of PI caused by Oerskovia"></img></a></p><p class="elsevierStylePara">Table 1&#46; Review of cases of PI caused by Oerskovia</p>"
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