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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Here we present two cases of bacteremia related to catheter infection by this organism&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patient 1&#58; 85-year-old man with end-stage renal disease on hemodyalisis via permanent tunelled catheter&#44; was hospitalised in Nephrology for study something similar than a constitutional syndrome&#46; He related a period of two months characterised by weakness&#44; fever lower than 38<span class="elsevierStyleHsp" style=""></span>&#176;C without shivering&#44; and hyporexia with a lost of 10<span class="elsevierStyleHsp" style=""></span>kg&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The blood test showed leukocytosis &#40;10&#44;850&#47;&#62;L&#44; normal formula&#41;&#44; hemoglobin 12&#46;1<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; C-reactive protein 10<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; The rest of analyzed parameters were normal range&#46; Other studies&#44; including blood cultures&#44; tumor markers and computed topographies&#44; were conducted without any positive result&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As the patient remained with fever&#44; daptomycin and meropenem were initiated&#46; After 8 days of empiric antibiotic treatment&#44; blood cultures revealed a gram positive bacillus&#44; which was finally identified as a <span class="elsevierStyleItalic">Gordonia rubropertincta</span>&#46; Meropenem was stopped after a 14-day treatment&#44; and at the time of the discharge medical&#44; the patient was completely asymptomatic&#44; and blood cultures were negative&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two weeks later&#44; the patient came back with the same symptoms&#44; and new blood cultures revealed <span class="elsevierStyleItalic">G&#46; rubropertincta</span> again&#46; Meronem was administrated&#44; and then&#44; the tunneled catheter was removed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although cultures drawn from the dialysis catheter were all negative&#44; antibiotic treatment was given for 3 weeks more and a transesophageal echocardiography was performed being negative for endocarditis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patient 2&#58; A 91-year- old man&#44; on hemodyalisis via permanent tunelled catheter&#44; presented well-tolerated fever intradialysis with no other symptoms associated&#46; Blood test showed leukocytes 5890 &#40;neutrophils 79&#46;85&#41; and PCR 1&#44; with the remaining results normal&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Empiric antibiotic treatment with vancomycin was initiated&#44; and blood cultures isolated <span class="elsevierStyleItalic">Gordonia sputi</span>&#46; After 3 weeks treatment&#44; the patient was asymptomatic&#44; but a new control blood culture revealed <span class="elsevierStyleItalic">G&#46; sputi</span> again&#46; Then&#44; we administrated ciprofloxacin and the tunneled catheter was removed&#46; The last blood sample test was negative&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This is the first report of catheter related bacteraemia caused by <span class="elsevierStyleItalic">G&#46; rubropertincta</span> and <span class="elsevierStyleItalic">Sputti</span>&#44; confirming its pathogenic potential in dialysis patients&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Gordonia species are aerobic actinomycetes&#44; Gram-positive&#44; catalase-positive and weakly acid-fast bacilli&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> They are isolated from the environment&#44; useful properties in biotechnology&#44; but they also have been reported to cause infections&#46; Their identification by conventional methods is difficult&#44; so it is believed that a number of <span class="elsevierStyleItalic">Gordonia</span> spp&#46; infections are undetected&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Recently&#44; Ramanan et al&#46; reported 5 cases of Gordonia bacteremia colleted between 1999 and 2013&#46; In three cases the infection was related to a Hickman catheter&#44; and another was considered a contamination from a tunneled dialysis catheter&#46; Interestingly&#44; none of these species were <span class="elsevierStyleItalic">G&#46; rubropertincta</span>&#44; and in addition&#44; the infection in the hemodialysis patient was considered as a contaminant&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Our case report other specie&#44; <span class="elsevierStyleItalic">G&#46; rubropertincta</span>&#44; that was previously known as <span class="elsevierStyleItalic">Rhodoccoccus rubropertinctus</span> until 1989&#46; It is a rare pathogen that could cause a variety of infections in humans&#44; not only immunocompromised even immunocompetent hosts&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Although there is no standardized treatment due to the small number of cases reported&#44; it seems that <span class="elsevierStyleItalic">Gordonia</span> spp&#46; is usually susceptible to several antibiotic treatments&#44; and it has good response rates&#46; In our case&#44; antibiotic treatment with daptomycin and meropenem was not enough even long-term&#44; and removing the intravascular catheter was needed to get negative blood cultures&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion&#44; improvement in laboratory techniques will allow identifying ubiquitous microorganisms as <span class="elsevierStyleItalic">Gordonia</span> spp&#46;&#44; whom must be taken into account as responsible of infections in patients with hemodialysis catheters&#46; To ensure the eradication of these microorganism&#44; it would be advisable to remove the intravascular dispositive</p></span>"
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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
Autor para correspondencia
aelita.sv@gmail.com

Corresponding author.
, Esther Ortega, Borja Quiroga
Hospital la Princesa, Servicio de Nefrología, Madrid, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Here we present two cases of bacteremia related to catheter infection by this organism&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Patient 1&#58; 85-year-old man with end-stage renal disease on hemodyalisis via permanent tunelled catheter&#44; was hospitalised in Nephrology for study something similar than a constitutional syndrome&#46; He related a period of two months characterised by weakness&#44; fever lower than 38<span class="elsevierStyleHsp" style=""></span>&#176;C without shivering&#44; and hyporexia with a lost of 10<span class="elsevierStyleHsp" style=""></span>kg&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The blood test showed leukocytosis &#40;10&#44;850&#47;&#62;L&#44; normal formula&#41;&#44; hemoglobin 12&#46;1<span class="elsevierStyleHsp" style=""></span>g&#47;dL&#44; C-reactive protein 10<span class="elsevierStyleHsp" style=""></span>mg&#47;L&#46; The rest of analyzed parameters were normal range&#46; Other studies&#44; including blood cultures&#44; tumor markers and computed topographies&#44; were conducted without any positive result&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">As the patient remained with fever&#44; daptomycin and meropenem were initiated&#46; After 8 days of empiric antibiotic treatment&#44; blood cultures revealed a gram positive bacillus&#44; which was finally identified as a <span class="elsevierStyleItalic">Gordonia rubropertincta</span>&#46; Meropenem was stopped after a 14-day treatment&#44; and at the time of the discharge medical&#44; the patient was completely asymptomatic&#44; and blood cultures were negative&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Two weeks later&#44; the patient came back with the same symptoms&#44; and new blood cultures revealed <span class="elsevierStyleItalic">G&#46; rubropertincta</span> again&#46; Meronem was administrated&#44; and then&#44; the tunneled catheter was removed&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Although cultures drawn from the dialysis catheter were all negative&#44; antibiotic treatment was given for 3 weeks more and a transesophageal echocardiography was performed being negative for endocarditis&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Patient 2&#58; A 91-year- old man&#44; on hemodyalisis via permanent tunelled catheter&#44; presented well-tolerated fever intradialysis with no other symptoms associated&#46; Blood test showed leukocytes 5890 &#40;neutrophils 79&#46;85&#41; and PCR 1&#44; with the remaining results normal&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Empiric antibiotic treatment with vancomycin was initiated&#44; and blood cultures isolated <span class="elsevierStyleItalic">Gordonia sputi</span>&#46; After 3 weeks treatment&#44; the patient was asymptomatic&#44; but a new control blood culture revealed <span class="elsevierStyleItalic">G&#46; sputi</span> again&#46; Then&#44; we administrated ciprofloxacin and the tunneled catheter was removed&#46; The last blood sample test was negative&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">This is the first report of catheter related bacteraemia caused by <span class="elsevierStyleItalic">G&#46; rubropertincta</span> and <span class="elsevierStyleItalic">Sputti</span>&#44; confirming its pathogenic potential in dialysis patients&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">Gordonia species are aerobic actinomycetes&#44; Gram-positive&#44; catalase-positive and weakly acid-fast bacilli&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">1</span></a> They are isolated from the environment&#44; useful properties in biotechnology&#44; but they also have been reported to cause infections&#46; Their identification by conventional methods is difficult&#44; so it is believed that a number of <span class="elsevierStyleItalic">Gordonia</span> spp&#46; infections are undetected&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Recently&#44; Ramanan et al&#46; reported 5 cases of Gordonia bacteremia colleted between 1999 and 2013&#46; In three cases the infection was related to a Hickman catheter&#44; and another was considered a contamination from a tunneled dialysis catheter&#46; Interestingly&#44; none of these species were <span class="elsevierStyleItalic">G&#46; rubropertincta</span>&#44; and in addition&#44; the infection in the hemodialysis patient was considered as a contaminant&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Our case report other specie&#44; <span class="elsevierStyleItalic">G&#46; rubropertincta</span>&#44; that was previously known as <span class="elsevierStyleItalic">Rhodoccoccus rubropertinctus</span> until 1989&#46; It is a rare pathogen that could cause a variety of infections in humans&#44; not only immunocompromised even immunocompetent hosts&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">3&#44;4</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">Although there is no standardized treatment due to the small number of cases reported&#44; it seems that <span class="elsevierStyleItalic">Gordonia</span> spp&#46; is usually susceptible to several antibiotic treatments&#44; and it has good response rates&#46; In our case&#44; antibiotic treatment with daptomycin and meropenem was not enough even long-term&#44; and removing the intravascular catheter was needed to get negative blood cultures&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">In conclusion&#44; improvement in laboratory techniques will allow identifying ubiquitous microorganisms as <span class="elsevierStyleItalic">Gordonia</span> spp&#46;&#44; whom must be taken into account as responsible of infections in patients with hemodialysis catheters&#46; To ensure the eradication of these microorganism&#44; it would be advisable to remove the intravascular dispositive</p></span>"
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