Urinary infection due to Chryseobacterium indologenes
Infección urinaria por Chryseobacterium indologenes
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Isabel" "apellidos" => "Acosta-Ochoa" "email" => array:1 [ 0 => "macostao@saludcastillayleon.es" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:3 [ "nombre" => "Antonio" "apellidos" => "Rodrigo-Parra" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 2 => array:3 [ "nombre" => "Flor" "apellidos" => "Rodríguez-Martín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 3 => array:3 [ "nombre" => "Antonio" "apellidos" => "Molina-Miguel" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => " Servicio de Nefrología, Hospital Río Hortega, Valladolid, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Infección urinaria por Chryseobacterium indologenes" ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">To the Editor:</span></p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Chryseobacteria</span> are a group of gram-negative, non-fermenting, non-motile, catalase, oxidase and indole positive aerobic bacilli. <span class="elsevierStyleItalic">C. meningosepticum</span> is the most pathogenic, while <span class="elsevierStyleItalic">C. indologenes</span> is the most common, and is generally isolated in immunocompromised patients.<span class="elsevierStyleSup">1,2</span></p><p class="elsevierStylePara">We report the case of an 86-year-old female with insulin-dependent type 2 diabetes, of over 20 years’ progression, with diabetic nephropathy and retinopathy, high blood pressure, also with long progression and obesity. Stage 4 chronic kidney disease, with non-nephrotic proteinuria. Urinary infection due to <span class="elsevierStyleItalic">E. coli</span> in April 2010. She was admitted to hospital due to symptoms of decompensated congestive heart failure, associated with worsening of renal failure, sacral oedema and probable respiratory infection. She was started on diuretic and fluid management. Urine culture was performed and an increase of >100,000CFU/ml of ESBL carrying <span class="elsevierStyleItalic">Escherichia coli</span> and <span class="elsevierStyleItalic">Chryseobacterium indologenes</span> are found. The patient was being treated empirically with levofloxacin (with doses adjusted according to renal function) and did not display fever or haemodynamic instability, with a good clinical progression and a return to her baseline creatinine figures.</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Chryseobacterium indologenes</span> is found in soil, plants, food, fresh water, salt water and drinking water (it resists chlorination), but despite its extensive distribution in nature, it is not a part of the normal human microflora. In hospitals, it is isolated in water systems and surfaces of equipment and humid medical supplies (ventilators, tubes, humidifiers and others).<span class="elsevierStyleSup">2</span> It is not very pathogenic, although it forms a biofilm and produces a protease that may be important in its virulence.<span class="elsevierStyleSup">3,4 </span><span class="elsevierStyleItalic">In vitro</span>, its colony is circular, smooth, mucous and 1-2mm in diameter. The study of susceptibility is not standardised, and as such, antibiograms should be performed by dilution. It produces a metallo-β-lactamase that provides resistance to carbapenems. The most effective antimicrobials are levofloxacin, trimethoprim/sulfamethoxazole and piperacillin/tazobactam (>90% susceptibility). Ciprofloxacin, cefepime and ceftazidime show an activity level of around 85%; aminoglycosides, other β-lactams, chloramphenicol, linezoid and glycopeptides are not usually effective.<span class="elsevierStyleSup">1,3</span></p><p class="elsevierStylePara">Although it is an uncommon germ, it must be considered as an uncommon cause of bacteraemia, especially in patients with invasive medical devices, immunocompromised patients (including diabetics) and patients with previous broad-spectrum antibiotic treatment.<span class="elsevierStyleSup">4,5</span> Since it is a Beta-lactamase producer and presents multiple resistances to very strong antibiotics, empirical antibiotic therapy may not cover this bacillus. More epidemiological studies are required to explain the transmission mechanism and develop effective preventive measures.<span class="elsevierStyleSup">1,2</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Conflicts of interest</span></p><p class="elsevierStylePara"> </p><p class="elsevierStylePara">The authors declare that they have no conflicts of interest related to the contents of this article.</p>" "pdfFichero" => "P1-E557-S4311-A11942-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Chou DW, Wu SL, Lee CT, Tai FT, Yu WL. Clinical characteristics, antimicrobial susceptibilities, and outcomes of patients with Chryseobacterium indologenes bacteremia in an intensive care unit. Jpn J Infect Dis 2011;64:520-524. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22116334" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lin YT, Jeng YY, Lin ML, Yu KW, Wang FD, Liu CY. Clinical and microbiological characteristics of Chryseobacterium indologenes bacteremia. J Microbiol Immunol Infect 2010;43(6):498-505. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21195977" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Sakurada ZA. Chryseobacterium indologenes. Rev Chilena Infectol 2008;25(6):446. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19194608" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Olivera A, Alarcón T, Caballero C, Cantón R. Diagnóstico microbiológico de la colonización-infección broncopulmonar en el paciente con fibrosis quística. Enferm Infecc Microbiol Clin 2009;27(2):89-104. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19232782" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bhuyar G, Jain S, Shah H, Mehta VK. Urinary tract infection by Chryseobacterium indologenes. Indian J Med Microbiol 2012;30(3):370-2. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22885214" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003300000004/v0_201502091629/X2013251413052623/v0_201502091630/en/main.assets" "Apartado" => array:4 [ "identificador" => "35437" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor - Brief Case Reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003300000004/v0_201502091629/X2013251413052623/v0_201502091630/en/P1-E557-S4311-A11942-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251413052623?idApp=UINPBA000064" ]
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