Hyeun Gyeo Lee

Multidrug-Resistant Corynebacterium striatum Bacteremia: First Case in Korea

Dear Editor Corynebacteria are aerobic, non-spore forming, and gram-positive bacilli that are commensal organisms of skin and mucosal membranes. C. striatum, like other Corynebacterium species, is a part of the normal human skin flora; therefore, it has been frequently dismissed as a blood and airway sample contaminant in the past. However, C. striatum is emerging as a cause of bloodstream infections and endocarditis [1]. Moreover, C. striatum infection outbreaks have been reported in long-stay patients with underlying disease [2]. We report a case of C. striatum bacteremia in a patient who had undergone gastrostomy. To our knowledge, there has been no report of C. striatum bacteremia in Korea so far. A 64-yr-old quadriplegic man visited the outpatient rehabilitation clinic for gastrostomy tube change. Before visiting our hospital, he was admitted to a secondary hospital and had hypertension and diabetes mellitus. Nine months before this visit, quadriplegia developed because of hypoxic ischemic encephalopathy; he underwent tracheostomy and gastrostomy tube placement. He was admitted to our hospital owing to persistent low-grade fever with blood pressure of 156/89 mmHg. The white blood cell count was 6.02×109/L (86% segmented neutrophils), and C-reactive protein level was 3.34 mg/dL (reference range: 128 µg/mL), and erythromycin (>128 µg/mL). At first, the physician assumed that C. striatum was a contaminant and the fever was caused by a urinary tract infection on the basis of the past history. Thus, only intravenous piperacillin/tazobactam was administered for the possible urinary tract infection. Culture for medical devices such as the gastrostomy or tracheostomy tubes was not performed. However, fever did not subside and C-reactive protein level was elevated; follow-up blood cultures performed on the 6th day of admission revealed C. striatum growth. The patient was continuously given intravenous piperacillin/tazobactam. As the fever subsided, he was transferred to a provincial medical center. The patient was readmitted for check-up a month after discharge and showed no sign of infection. It is difficult to distinguish simple colonization from real infection when Corynebacterium spp. are recovered from specimens [4]. C. striatum are commonly isolated in patients with significant underlying illnesses [2] and has close association with various medical devices such as prosthetic valve/joint and central venous catheter [5] and long hospitalization. In this case, the patient suffered from diabetes, hypertension, tracheostomy, and gastrostomy. Additionally, he had stayed at a secondary health care center before being admitted to our hospital. These factors probably increased the patients risk of C. striatum infection. Additionally, each of the blood culture sets was collected at regularly spaced intervals with adequate blood volumes, and turned positive within 24 hr. One of the recent issues related to C. striatum is the emergence and spread of multidrug resistance. Generally, most of the reported C. striatum isolates were susceptible to a wide range of antibiotics [6]; however, recent studies showed the emergence of multi-drug resistant strains with increasing use of broad-spectrum antibiotics (Table 1) [1, 4, 6, 7]. When invasive C. striatum infection is suspected, most initial therapies should include vancomycin, because in vitro resistance to vancomycin has not been reported in any of the Corynebacterium species [5]. If the patient is allergic to vancomycin, daptomycin may be an alternative. Fernandez et al. [1] reported successful treatment of a case of multidrug-resistant C. striatum endocarditis with daptomycin. Table 1 Multidrug resistant Corynebacterium striatum in the literature In conclusion, with increasing numbers of immunosuppressed patients and indwelling medical devices, C. striatum infections will be more commonly found and should never be overlooked as a contaminant. This report suggests the need to increase awareness of C. striatum as a pathogen causing bloodstream infections.

A Case of Brain Abscess due to Parvimonas micra

is a non-spore-forming anaerobic gram-positive coccus, widely distributed as normal flora in the skin, vagina and mucosa, and able to cause opportunistic infections, particularly endocardi-tis and brain abscess following dental manipulations. A 49-year-old woman was hospitalized due to fever and headache. She had been diagnosed with perio-dontitis at the beginning of fever. A brain abscess was noted in the right temporal lobe on the brain CT, and she was treated with ceftriaxone, isepamicin and metronidazole. In the next day, abscess was as-pirated and drained by a surgical procedure. An or-ganism was isolated from an anaerobic culture of the abscess aspirate, and was identified as

A Case of Bacteremia Caused by Rothia dentocariosa

는 주로 구강에서 분리되지만 혈액, 호흡기 분비물, 농양, 창상, 복막투석액과 눈 등의 다양한 검체에서도 분리된다. 이 균종에 의한 인체 감염은 1970년대 중반부터 보고되기 시작하여 치주염 질환 [4,5], 모소낭 감염[6], 충수부위 농[7], 골수염[8], 폐종양을 동반한 폐렴[9], 복막투석 환자에서의 복막염[10,11]과 같은 경증부터 심각한 감염까지 다양하며 문헌상의 보고는 주로 심내막염과 균혈증이다[8,12-15]. 최근에는 건강한 초산 여성의 자궁내 태아 사망으로 사산된 태아의 혈액에서 이 균의 분리예도 보고되었다[16]. 국내에서 이 균종에 의한 패혈증은 2004년 Shin 등[15]이 심내막염을 동반하지 않은 meconium aspiration syndrome을 가지고 있던 신생아에서 처음으로 보고하였다. 저자들은 최근에 국내에서 두 번째로

Microbiological Characteristics according to Transudative and Exudative Effusion in Pleural Fluid Culture

Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, KoreaA total of 1,132 pleural fluid culture results obtained from October 2012 to July 2014 were analyzed to eluci-date the microbiological characteristics according to transudative and exudative pleural fluid. The pleural fluid cultures were performed using aerobic and anae-robic blood culture bottles. The blood and pleural fluid for total protein, lactate dehydrogenase, and glucose measurement were submitted to laboratory at the same time with pleural fluid cultures. The rates for culture positivity, anaerobes isolation, and polymicrobials be-tween transudative and exudative pleural fluid were 5.2% vs. 10.4%, 14.8% vs. 7.8%, and 14.8% vs. 10.9%.