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Granulicatella adiacens bacteremia after flexible sigmoidoscopy
+
MODEL
Journal of the Formosan Medical Association (2015) xx, 1e3
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jfma-online.com
CORRESPONDENCE
Granulicatella adiacens bacteremia after flexible sigmoidoscopy Chang-Hua Chen a,*, Chia-Wei Yang b, Chien-Te Li c, Ru-Hua Hsiu d a Division of Infectious Disease, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan b Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan c Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan d Department of Laboratory Medicine, Changhua Christian Hospital, Changhua, Taiwan
Received 30 June 2015; received in revised form 7 July 2015; accepted 14 July 2015
Endoscopy is a procedure commonly used for diagnosis and therapy, whereas infection is a common complication of endoscopy. The earliest descriptions of bacteremia resulting from lower gastrointestinal procedures were related to rigid proctosigmoidoscopy, with infection rates ranging from 0% to 12%.1 Fastidious Gram-positive nutritionally variant streptococci are classified into two genera: Abiotrophia and Granulicatella (which includes Granulicatella adiacens, Granulicatella elegans, and Granulicatella balaenopterae). Endocarditis and bacteremia are the most common G. adiacenseassociated clinical syndromes2; however, G. adiacens bacteremia has seldom been reported after invasive procedures. Herein we report a case of G. adiacens bacteremia after flexible sigmoidoscopy. An 81-year-old man with a history of chronic obstructive pulmonary disease (COPD) was maintained on a daily dose of prednisone, which was reduced to 5 mg/d when his COPD
Conflicts of interest: The authors have no conflicts of interest relevant to this article. * Corresponding author. Division of Infectious Disease, Department of Internal Medicine, Centre for Infectious Diseases Research, Changhua Christian Hospital, 135 Nanhsiau Street, Changhua, Taiwan. E-mail address: [email protected] (C.-H. Chen).
became steroid-dependent. He presented to the emergency room with abdominal distension and diarrhea and was admitted with a tentative diagnosis of COPD with secondary bacterial infection, and ileus. Diagnostic flexible sigmoidoscopy was performed, revealing colonic pseudoobstruction. The patient developed fever after the procedure, and a combination of ampicillin/sulbactam and clarithromycin was prescribed for empirical therapy. G. adiacens was isolated from blood culture on the 3rd day, using the Vitek GP card and the Vitek-2 automated system (bioMe ´rieux, Hazelwood, MO, USA). The prescription for antibiotics was changed to 2000 mg of ampicillin every 4 hours plus 80 mg of gentamicin every 8 hours based on susceptibility test. In addition, we further examined the foci of infection and found no evidence of vegetation on echocardiogram and no active lesions on gallium scan. The patient was discharged after a 2-week administration of ampicillin plus gentamicin and after follow-up blood culture yielded negative results. Follow up was conducted in an outpatient clinic, and no relapse event occurred. To our knowledge, this is the first reported case of G. adiacens bacteremia after flexible sigmoidoscopy in Taiwan. Table 1 presents a summary of cases of G. adiacens bacteremia after invasive procedures, which were obtained from systematic searches of the literature in bibliographical databases.
http://dx.doi.org/10.1016/j.jfma.2015.07.018 0929-6646/Copyright ª 2015, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
Please cite this article in press as: Chen C-H, et al., Granulicatella adiacens bacteremia after flexible sigmoidoscopy, Journal of the Formosan Medical Association (2015), http://dx.doi.org/10.1016/j.jfma.2015.07.018
+
MODEL
2
C.-H. Chen et al. Table 1
Summary of Granulicatella adiacens bacteremia after invasive procedures.
Case Number
Author, Country, year
Sex
Age (years)
Final clinical diagnosis
Underlying conditions
Predisposing factors
Antimicrobial therapy
Duration (weeks)
Outcome
1
Chen CH (2015), Taiwan De Luca M (2013), Italy De Luca M(2013), Italy, 2013 Garibyan V(2013), USA Hernando Real S (2007) , Spain Jeng A (2005), California, USA Cerceo E (2004), Philadelphia USA Cerceo E (2004), Philadelphia USA Hepburn MJ (2003), Houston, USA Perkins A (2003), Spain Schlegel L (1999), France Biermann C (1999) , Germany
M
81
PriBSI
SigFS
Ap + G
2
S
F
7
IE
6
S
5
IE
Ross-Konno procedure CarCath
V + merop
M
COPD, old HI, SD Shone syndrome IPS
cipro + merop
4
S
M
MA
IE
RHD
DP
P+G
6
S
F
77
IE
AS, MR
DP
Ap + G
6
S
M
18
IE
CongHD
DP
V+G+R
6
S
F
32
CNSI
ESC
P+G
4
S
F
53
CNSI
SAH
CranOT, ResT Clip, VPS
P+G
4
S
F
68
SA
NM
ATC, ASI
Ce + G
4
S
M
57
IE
MR
DP
Ap + G
4
S
F
49
CNSI
NM
CTM
V
2
S
F
46
CNSI
AsTC
CranOT, ResT
CTX + G
2
S
2 3 4 5 6 7 8 9 10 11 12
Abbreviations: Ap, ampicillin; AS, aortic stenosis; ASI, arthroscopic irrigation; AsTC, astrocytoma; ATC, arthrocentesis; CarCath, cardiac catheterization; Ce, cefazolin; cipro, ciprofloxacin; Clip, clipping of a middle cerebral artery aneurysm; CNSI, central nervous system infections; CongHD, congenital heart disease; COPD, chronic obstructive pulmonary disease; CranOT, craniotomy; CTM, computed tomography-guided myelography with injection of contrast medium; CTX, ceftriaxone; DP, dental procedures; ESC, ethmoid sinus carcinoma; F, female; G, gentamicin; HI, head injury; IE, infective endocarditis; IPS, infundibular pulmonary stenosis; M, male; MA, middleaged; merop, meropenem; MR, mitral regurgitation; NM, no mention in the article; P, penicillin; PriBSI, primary bloodstream infection; R, rifampicin; ResT, resection of tumor; RHD, rheumatic heart disease; SA, septic arthritis; S, survived; SAH, subarachnoid hemorrhage; SD, senile dementia; SigFS, sigmoid fiberscopy; V, vancomycin; VPS, ventriculoperitoneal shunt placement De Luca M, Amodio D, Chiurchiu ` S, Castelluzzo MA, Rinelli G, Bernaschi, et al. Granulicatella bacteraemia in children: two cases and review of the literature. BMC Pediatr 2013;13:61. http://dx.doi.org/1186/1471-2431-13-61. Garibyan V, Shaw D. Bivalvular endocarditis due to Granulicatella adiacens. Am J Case Rep 2013;14:435e8. http://dx.doi.org/10.12659/ AJCR.889206. Hernando Real S, Carrero Gonza ´lez P, Chaves Gonza ´lez F, Gonza ´lez Gonza ´lez R. Endocarditis due to Granulicatella adiacens in an old patient. Med Clin (Barc) 2007;128:758 [Article in Spanish]. Jeng A, Chen J, Katsivas T. Prosthetic valve endocarditis from Granulicatella adiacens (nutritionally variant streptococci). J Infect 2005;51:e125e9. Cerceo E, Christie JD, Nachamkin I, Lautenbach E. Central nervous system infections due to Abiotrophia and Granulicatella species: an emerging challenge? Diagn Microbiol Infect Dis 2004 Mar;48:161e5. Hepburn MJ, Fraser SL, Rennie TA, Singleton CM, Delgado Jr B. Septic arthritis caused by Granulicatella adiacens: diagnosis by inoculation of synovial fluid into blood culture bottles. Rheumatol Int 2003;23:255e7 Perkins A, Osorio S, Serrano M, del Ray MC, Sarria ´ C, Domingo D, Lo ´pez-Brea M. A case of endocarditis due to Granulicatella adiacens. Clin Microbiol Infect 2003;9:576e7. Schlegel L, Merlet C, Laroche JM, Fre ´maux A, Geslin P. Iatrogenic meningitis due to Abiotrophia defectiva after myelography. Clin Infect Dis 1999;28:155e6. Biermann C, Fries G, Jehnichen P, Bhakdi S, Husmann M. Isolation of Abiotrophia adiacens from a brain abscess which developed in a patient after neurosurgery. J Clin Microbiol 1999;37:769e71.
Flexible sigmoidoscopyeassociated infections are most commonly caused by enteric bacteria.1,3 G. adiacens infection, which was reported in this study, is rare. Although we could not prove a causal association between flexible sigmoidoscopy and infection in this study, certain patient populations could be at higher risk for
infectious complications after flexible sigmoidoscopy. Bianco et al4 reported clinically significant bacteremia within 24 hours of upper endoscopy in 19% of cases, and patients on prednisone therapy were believed to be at a particularly high risk. These results are similar to our results.
Please cite this article in press as: Chen C-H, et al., Granulicatella adiacens bacteremia after flexible sigmoidoscopy, Journal of the Formosan Medical Association (2015), http://dx.doi.org/10.1016/j.jfma.2015.07.018
+
MODEL
Granulicatella adiacens bacteremia In conclusion, most lower gastrointestinal endoscopic procedures are generally associated with a low frequency of postprocedural infections. Recognizing the infectious complications of postendoscopic procedures can aid in the clinical management of such complications. We believe that accurate endoscopic techniques and skills are of paramount importance in minimizing the risk of endoscopyrelated bacteremia. Antibiotic prophylaxis is indicated for select patients.
Acknowledgments This study was supported by a grant from the Changhua Christian Hospital, Changhua, Taiwan (grant number 103CCH-IRP-001).
3
References 1. Nelson DB. Infectious disease complications of GI endoscopy: part I, endogenous infections. Gastrointest Endosc 2003;57: 546e56. 2. Senn L, Entenza JM, Greub G, Jaton K, Wenger A, Bille J, et al. Bloodstream and endovascular infections due to Abiotrophia defectiva and Granulicatella species. BMC Infect Dis 2006;6:9. 3. Llach J, Elizalde JI, Bordas JM, Gines A, Almela M, Sans M, et al. Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower gastrointestinal endoscopy. Gastrointest Endosc 1999;49:214e7. 4. Bianco JA, Pepe MS, Higano C, Appelbaum FR, McDonald GB, Singer JW. Prevalence of clinically relevant bacteremia after upper gastrointestinal endoscopy in bone marrow transplant recipients. Am J Med 1990;89:134e6.
Please cite this article in press as: Chen C-H, et al., Granulicatella adiacens bacteremia after flexible sigmoidoscopy, Journal of the Formosan Medical Association (2015), http://dx.doi.org/10.1016/j.jfma.2015.07.018
MODEL
Journal of the Formosan Medical Association (2015) xx, 1e3
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.jfma-online.com
CORRESPONDENCE
Granulicatella adiacens bacteremia after flexible sigmoidoscopy Chang-Hua Chen a,*, Chia-Wei Yang b, Chien-Te Li c, Ru-Hua Hsiu d a Division of Infectious Disease, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan b Division of Gastroenterology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan c Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan d Department of Laboratory Medicine, Changhua Christian Hospital, Changhua, Taiwan
Received 30 June 2015; received in revised form 7 July 2015; accepted 14 July 2015
Endoscopy is a procedure commonly used for diagnosis and therapy, whereas infection is a common complication of endoscopy. The earliest descriptions of bacteremia resulting from lower gastrointestinal procedures were related to rigid proctosigmoidoscopy, with infection rates ranging from 0% to 12%.1 Fastidious Gram-positive nutritionally variant streptococci are classified into two genera: Abiotrophia and Granulicatella (which includes Granulicatella adiacens, Granulicatella elegans, and Granulicatella balaenopterae). Endocarditis and bacteremia are the most common G. adiacenseassociated clinical syndromes2; however, G. adiacens bacteremia has seldom been reported after invasive procedures. Herein we report a case of G. adiacens bacteremia after flexible sigmoidoscopy. An 81-year-old man with a history of chronic obstructive pulmonary disease (COPD) was maintained on a daily dose of prednisone, which was reduced to 5 mg/d when his COPD
Conflicts of interest: The authors have no conflicts of interest relevant to this article. * Corresponding author. Division of Infectious Disease, Department of Internal Medicine, Centre for Infectious Diseases Research, Changhua Christian Hospital, 135 Nanhsiau Street, Changhua, Taiwan. E-mail address: [email protected] (C.-H. Chen).
became steroid-dependent. He presented to the emergency room with abdominal distension and diarrhea and was admitted with a tentative diagnosis of COPD with secondary bacterial infection, and ileus. Diagnostic flexible sigmoidoscopy was performed, revealing colonic pseudoobstruction. The patient developed fever after the procedure, and a combination of ampicillin/sulbactam and clarithromycin was prescribed for empirical therapy. G. adiacens was isolated from blood culture on the 3rd day, using the Vitek GP card and the Vitek-2 automated system (bioMe ´rieux, Hazelwood, MO, USA). The prescription for antibiotics was changed to 2000 mg of ampicillin every 4 hours plus 80 mg of gentamicin every 8 hours based on susceptibility test. In addition, we further examined the foci of infection and found no evidence of vegetation on echocardiogram and no active lesions on gallium scan. The patient was discharged after a 2-week administration of ampicillin plus gentamicin and after follow-up blood culture yielded negative results. Follow up was conducted in an outpatient clinic, and no relapse event occurred. To our knowledge, this is the first reported case of G. adiacens bacteremia after flexible sigmoidoscopy in Taiwan. Table 1 presents a summary of cases of G. adiacens bacteremia after invasive procedures, which were obtained from systematic searches of the literature in bibliographical databases.
http://dx.doi.org/10.1016/j.jfma.2015.07.018 0929-6646/Copyright ª 2015, Elsevier Taiwan LLC & Formosan Medical Association. All rights reserved.
Please cite this article in press as: Chen C-H, et al., Granulicatella adiacens bacteremia after flexible sigmoidoscopy, Journal of the Formosan Medical Association (2015), http://dx.doi.org/10.1016/j.jfma.2015.07.018
+
MODEL
2
C.-H. Chen et al. Table 1
Summary of Granulicatella adiacens bacteremia after invasive procedures.
Case Number
Author, Country, year
Sex
Age (years)
Final clinical diagnosis
Underlying conditions
Predisposing factors
Antimicrobial therapy
Duration (weeks)
Outcome
1
Chen CH (2015), Taiwan De Luca M (2013), Italy De Luca M(2013), Italy, 2013 Garibyan V(2013), USA Hernando Real S (2007) , Spain Jeng A (2005), California, USA Cerceo E (2004), Philadelphia USA Cerceo E (2004), Philadelphia USA Hepburn MJ (2003), Houston, USA Perkins A (2003), Spain Schlegel L (1999), France Biermann C (1999) , Germany
M
81
PriBSI
SigFS
Ap + G
2
S
F
7
IE
6
S
5
IE
Ross-Konno procedure CarCath
V + merop
M
COPD, old HI, SD Shone syndrome IPS
cipro + merop
4
S
M
MA
IE
RHD
DP
P+G
6
S
F
77
IE
AS, MR
DP
Ap + G
6
S
M
18
IE
CongHD
DP
V+G+R
6
S
F
32
CNSI
ESC
P+G
4
S
F
53
CNSI
SAH
CranOT, ResT Clip, VPS
P+G
4
S
F
68
SA
NM
ATC, ASI
Ce + G
4
S
M
57
IE
MR
DP
Ap + G
4
S
F
49
CNSI
NM
CTM
V
2
S
F
46
CNSI
AsTC
CranOT, ResT
CTX + G
2
S
2 3 4 5 6 7 8 9 10 11 12
Abbreviations: Ap, ampicillin; AS, aortic stenosis; ASI, arthroscopic irrigation; AsTC, astrocytoma; ATC, arthrocentesis; CarCath, cardiac catheterization; Ce, cefazolin; cipro, ciprofloxacin; Clip, clipping of a middle cerebral artery aneurysm; CNSI, central nervous system infections; CongHD, congenital heart disease; COPD, chronic obstructive pulmonary disease; CranOT, craniotomy; CTM, computed tomography-guided myelography with injection of contrast medium; CTX, ceftriaxone; DP, dental procedures; ESC, ethmoid sinus carcinoma; F, female; G, gentamicin; HI, head injury; IE, infective endocarditis; IPS, infundibular pulmonary stenosis; M, male; MA, middleaged; merop, meropenem; MR, mitral regurgitation; NM, no mention in the article; P, penicillin; PriBSI, primary bloodstream infection; R, rifampicin; ResT, resection of tumor; RHD, rheumatic heart disease; SA, septic arthritis; S, survived; SAH, subarachnoid hemorrhage; SD, senile dementia; SigFS, sigmoid fiberscopy; V, vancomycin; VPS, ventriculoperitoneal shunt placement De Luca M, Amodio D, Chiurchiu ` S, Castelluzzo MA, Rinelli G, Bernaschi, et al. Granulicatella bacteraemia in children: two cases and review of the literature. BMC Pediatr 2013;13:61. http://dx.doi.org/1186/1471-2431-13-61. Garibyan V, Shaw D. Bivalvular endocarditis due to Granulicatella adiacens. Am J Case Rep 2013;14:435e8. http://dx.doi.org/10.12659/ AJCR.889206. Hernando Real S, Carrero Gonza ´lez P, Chaves Gonza ´lez F, Gonza ´lez Gonza ´lez R. Endocarditis due to Granulicatella adiacens in an old patient. Med Clin (Barc) 2007;128:758 [Article in Spanish]. Jeng A, Chen J, Katsivas T. Prosthetic valve endocarditis from Granulicatella adiacens (nutritionally variant streptococci). J Infect 2005;51:e125e9. Cerceo E, Christie JD, Nachamkin I, Lautenbach E. Central nervous system infections due to Abiotrophia and Granulicatella species: an emerging challenge? Diagn Microbiol Infect Dis 2004 Mar;48:161e5. Hepburn MJ, Fraser SL, Rennie TA, Singleton CM, Delgado Jr B. Septic arthritis caused by Granulicatella adiacens: diagnosis by inoculation of synovial fluid into blood culture bottles. Rheumatol Int 2003;23:255e7 Perkins A, Osorio S, Serrano M, del Ray MC, Sarria ´ C, Domingo D, Lo ´pez-Brea M. A case of endocarditis due to Granulicatella adiacens. Clin Microbiol Infect 2003;9:576e7. Schlegel L, Merlet C, Laroche JM, Fre ´maux A, Geslin P. Iatrogenic meningitis due to Abiotrophia defectiva after myelography. Clin Infect Dis 1999;28:155e6. Biermann C, Fries G, Jehnichen P, Bhakdi S, Husmann M. Isolation of Abiotrophia adiacens from a brain abscess which developed in a patient after neurosurgery. J Clin Microbiol 1999;37:769e71.
Flexible sigmoidoscopyeassociated infections are most commonly caused by enteric bacteria.1,3 G. adiacens infection, which was reported in this study, is rare. Although we could not prove a causal association between flexible sigmoidoscopy and infection in this study, certain patient populations could be at higher risk for
infectious complications after flexible sigmoidoscopy. Bianco et al4 reported clinically significant bacteremia within 24 hours of upper endoscopy in 19% of cases, and patients on prednisone therapy were believed to be at a particularly high risk. These results are similar to our results.
Please cite this article in press as: Chen C-H, et al., Granulicatella adiacens bacteremia after flexible sigmoidoscopy, Journal of the Formosan Medical Association (2015), http://dx.doi.org/10.1016/j.jfma.2015.07.018
+
MODEL
Granulicatella adiacens bacteremia In conclusion, most lower gastrointestinal endoscopic procedures are generally associated with a low frequency of postprocedural infections. Recognizing the infectious complications of postendoscopic procedures can aid in the clinical management of such complications. We believe that accurate endoscopic techniques and skills are of paramount importance in minimizing the risk of endoscopyrelated bacteremia. Antibiotic prophylaxis is indicated for select patients.
Acknowledgments This study was supported by a grant from the Changhua Christian Hospital, Changhua, Taiwan (grant number 103CCH-IRP-001).
3
References 1. Nelson DB. Infectious disease complications of GI endoscopy: part I, endogenous infections. Gastrointest Endosc 2003;57: 546e56. 2. Senn L, Entenza JM, Greub G, Jaton K, Wenger A, Bille J, et al. Bloodstream and endovascular infections due to Abiotrophia defectiva and Granulicatella species. BMC Infect Dis 2006;6:9. 3. Llach J, Elizalde JI, Bordas JM, Gines A, Almela M, Sans M, et al. Prospective assessment of the risk of bacteremia in cirrhotic patients undergoing lower gastrointestinal endoscopy. Gastrointest Endosc 1999;49:214e7. 4. Bianco JA, Pepe MS, Higano C, Appelbaum FR, McDonald GB, Singer JW. Prevalence of clinically relevant bacteremia after upper gastrointestinal endoscopy in bone marrow transplant recipients. Am J Med 1990;89:134e6.
Please cite this article in press as: Chen C-H, et al., Granulicatella adiacens bacteremia after flexible sigmoidoscopy, Journal of the Formosan Medical Association (2015), http://dx.doi.org/10.1016/j.jfma.2015.07.018