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Intravenous line infection due to Ochrobactrum anthropi (CDC Group Vd) in a normal host
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i0uS D|SEASE! .........................
Intravenous line infection due to Ochrobactrum anthropi (CDC Group Vd) in a normal host M . V a n e s s a Gill, M D , H u e Ly, M D , M i a n M u e e n u d d i n , M D , P a u l E. S c h o c h , P h D , a n d B u r k e A. C u n h a , M D , M i n e o l a a n d S t o n y B r o o k , N.Y.
Ochrobactrum anthropi, formerly k n o w n as Achromobacter species (CDC group Vd), is an aerobic, gramnegative bacillus widely distributed in aquatic environments. Most important, it has been implicated as a cause of intravenous line infection in i m m u n o c o m p r o m i s e d hosts with solid tumors or hematologic malignancies. Trimethoprim-sulfamethoxazole and aminoglycosides are usually active against O. anthropi, but this organism is usually resistant to ~-lactam antibiotics. Because O. anthropi is a low-virulence organism, patients with intravenous-line infections have been cured without removal of the intravenous catheter. We describe a case of intravenous-line infection in a normal host that was successfully resolved after catheter removal. (Heart Lung ® 1997;26:335-6)
O
chrobactrum anthropi, Achromobacter s p e c i e s
formerly known as (CDC g r o u p Vd), is a gram-negative aerobic bacillus, widely d i s t r i b u t e d in t h e e n v i r o n m e n t . ~'3 H o w e v e r , it r a r e l y is a c a u s e of n o s o c o m i a l i n f e c t i o n . 4"~ W e d e s c r i b e a n O. anthropi b a c t e r e m i a t h a t r e s o l v e d a f t e r r e m o v a l of t h e c e n t r a l v e n o u s c a t h e t e r . A 45-year-old man p r e s e n t e d with sternal chest pain, but the physical examination was normal. His white blood cell (WBC) count was 13,200 mm 3 with a differential of 74% granulocytes, 21% lymphocytes, and 5% monocytes. Electrocardiogram revealed an inferior wall myocardial infarction, and the chest radiograph was normal. Cardiac catheterization results showed triple*vessel coronary artery d i s e a s e . The patient underwent an uncomplicated coronary artery bypass grafting. He did not receive any blood or blood products. TWo days later, he experienced a temperature of 102.9 ° F, with a WBC count of 19,200 mm 3 with left shift. Blood cultures drawn from the Cordis line, two arterial lines, and blood were all positive for O. anthropi, formerly known as Achromobacter species (CDC group Vd). The Cordis and arterial catheters were removed but
From the infectious Disease Division and the Department of Pathology, Winthrop~University Hospital, Mineola, and the State University of New York School of Medicine, Stony Brook. Reprint requests: Burke A. Cunha, MD, Chief, Infectious Disease Division, Winthrop~University Hospital, Mineola, NY i 1501. Copyright © i997 by Mosby-Year Book, Inc. 0i47~9563/97/$5.00+0 2/1179402
HEART & LUNG
VOL. 26, NO. 4
not cultured. Blood cultures I day later were negative. Although he did not receive any antibiotics, his temperature and WBC count normalized 4 days later, and he made an uneventful recovery. Bacteria, formerly belonging to the genus Achromobaeter aerobic gram-negative b a c i l l i - motile by peritrichous flagella, oxidase posit i v e - p r o d u c e acid oxidatively from carbohydrates and fail to produce 3~ketolactose.~ Strains with these characteristics were further divided i n t o A. xylosoxidans, w h i c h c o n t a i n e d two b i o t y p e s a n d an u n n a m e d s p e c i e s r e f e r r e d to a s g r o u p Vd b y t h e CDC. M e m b e r s of t h e Vd g r o u p , o r i g i n a l l y c o n s i s t i n g of two b i o t y p e s b u t l a t e r c o n s o l i d a t e d , can b e p r i m a r i l y d i f f e r e n t i a t e d from t h e f o r m e r b y t h e a b i l i t y to h y d r o l y z e u r e a a n d t h e f a i l u r e t o g r o w on c e t r i m i d e agar. 3 R e c e n t t a x o n o m i c s t u d i e s h a v e l e d t o t h e r e c l a s s i f i c a t i o n of t h e g r o u p Vd o r g a n i s m s w i t h i n t h e n e w g e n u s
Ochrobactrum. 4 Our isolate matched the mucoid variants d e s c r i b e d a s p i n p o i n t in s i z e a f t e r 24 h o u r s incu~ b a t i o n a t 35 ° C on M a c C o n k e y agar, with a m u c o i d c o l o n y 0.5 to 2.25 m m in d i a m e t e r a f t e r 48 hours. 3 T h e a n t i b i o t i c s u s c e p t i b i l i t y of our i s o l a t e was con*
sistent with most published case reports, 58 i.e., resistance to penicillins and cephalosporins, with susceptibility to trimethoprim*sulfamethoxazole and imipenem. O. anthropi appears to be an infrequent but widely distributed opportunistic pathogen, occur335
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ring in b l o o d , r e s p i r a t o r y tract s p e c i m e n s , urine, feces, w o u n d s , ears, abscesses, a n d e v e n in h o s p i t a l a p p a r a t u s a n d e n v i r o n m e n t a l sources. 4 O. anthropi i n t r a v e n o u s - l i n e s e p s i s has b e e n r e p o r t e d in i m m u n o c o m p r o m i s e d a n d i m m u n o c o m p e t e n t hosts, a n d m o s t h a v e b e e n successf u l l y t r e a t e d w i t h a n t i b i o t i c s . 9"1~ A few cases of O. anthropi b a c t e r e m i a h a v e o c c u r r e d as t h e r e s u l t of contaminated infusion products. Clinically, our patient had intravenous-line sepsis due to O. anthropi, a n d t h e p a t i e n t r e c o v e r e d after r e m o v a l of t h e catheter.
REFERENCES 1. Tatum HW, Ewing WH, Weaver RE. Miscellaneous gram-negative bacteria. In: Lennette EH, Spaulding FH, Truant JP, editors. Manual of clinical microbiology. 2nd ed. Washington, DC, American Society for Microbiology; 1974.p. 270-94. 2. Weaver RE, Tatum HW, Hollis, DG. The identification of unusual pathogenic gram-negative bacteria (Elizabeth O. King). Atlanta: Centers for Disease Control; 1972.
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3. Chester B, Cooper LH. Achromobacter species (CDC group Vd): morphological and biochemical characterization. I Clin Microbiol 1979;9:42%36. 4. Holmes B, Popoff M, Kiredjian M, KerstersK. Oehromobaetrum anthropi gen nov sp nov from human clinical specimens and previously known as group Vd. lnt J Syst Bacteriol 1988; 38:404-10. 5. Barson WJ, Cromer BA, Marcon MJ. Puncture wound osteochondritis of the foot caused by CDC group Vd. ] Clin Microbiol 1987;25:2014-6. 6. Kish MA, Buggy PB, Forbes BA. Bacteremia caused by Aehromobaeter species in an immunocompromised host. l Clin Microbiol 1984;19:947-8. 7. Appelbaum PC, Campbell DB. Pancreatic abscess associated with Achromobactergroup Vd biovar 1. I Clin Microbiol 1980; 12:282-3. 8. Van Horn KG, Gedris CA, Ahmed T, Wormser GP. Bacteremia and urinary tract infection associated with CDC group Vd biovar 2. J Clin Microbiol 1989;27:201-2.' 9. Cieslak TJ, Robb ML, Drabick C J, Fischer GW. Catheter-associated sepsis caused by Oehromobaetrumanthropi: report of a case and review of related nonfermentative bacteria. Clin Infect Dis 1992;14:902-7. 10. Gransden WR, Eykyn SI. Seven cases of bacteremia due to Ochromobaeterium anthropi. Clin infect Dis 1992; 15:1068-9.
11. Gill MV, Klein NC, Cunha BA. Unusual organisms causing intravenous line infections in compromised hosts; I: bacterial and algal infections. Infect Dis Clin Pract 1996;5:244-55.
BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of Heart & Lung ® are available to subscribers (only) for the 1997 issues from the Publisher at a cost of $30.00 for domestic, $38.52 for Canadian, and $36.00 for international subscribers for Vol. 26 (January-December)~ Shipping charges are included. Each bound volume contains a subject and an author index and all advertising is removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the Journal name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Dr., St. Louis, M O 63146-3318, USA; phone (800)453-4351 or (314)453-4351.
Subscriptions must be in force to qualify. Bound volumes are not available in place of regular Journal subscription.
336
JULY/AUGUST1997 HEART & LUNG
i0uS D|SEASE! .........................
Intravenous line infection due to Ochrobactrum anthropi (CDC Group Vd) in a normal host M . V a n e s s a Gill, M D , H u e Ly, M D , M i a n M u e e n u d d i n , M D , P a u l E. S c h o c h , P h D , a n d B u r k e A. C u n h a , M D , M i n e o l a a n d S t o n y B r o o k , N.Y.
Ochrobactrum anthropi, formerly k n o w n as Achromobacter species (CDC group Vd), is an aerobic, gramnegative bacillus widely distributed in aquatic environments. Most important, it has been implicated as a cause of intravenous line infection in i m m u n o c o m p r o m i s e d hosts with solid tumors or hematologic malignancies. Trimethoprim-sulfamethoxazole and aminoglycosides are usually active against O. anthropi, but this organism is usually resistant to ~-lactam antibiotics. Because O. anthropi is a low-virulence organism, patients with intravenous-line infections have been cured without removal of the intravenous catheter. We describe a case of intravenous-line infection in a normal host that was successfully resolved after catheter removal. (Heart Lung ® 1997;26:335-6)
O
chrobactrum anthropi, Achromobacter s p e c i e s
formerly known as (CDC g r o u p Vd), is a gram-negative aerobic bacillus, widely d i s t r i b u t e d in t h e e n v i r o n m e n t . ~'3 H o w e v e r , it r a r e l y is a c a u s e of n o s o c o m i a l i n f e c t i o n . 4"~ W e d e s c r i b e a n O. anthropi b a c t e r e m i a t h a t r e s o l v e d a f t e r r e m o v a l of t h e c e n t r a l v e n o u s c a t h e t e r . A 45-year-old man p r e s e n t e d with sternal chest pain, but the physical examination was normal. His white blood cell (WBC) count was 13,200 mm 3 with a differential of 74% granulocytes, 21% lymphocytes, and 5% monocytes. Electrocardiogram revealed an inferior wall myocardial infarction, and the chest radiograph was normal. Cardiac catheterization results showed triple*vessel coronary artery d i s e a s e . The patient underwent an uncomplicated coronary artery bypass grafting. He did not receive any blood or blood products. TWo days later, he experienced a temperature of 102.9 ° F, with a WBC count of 19,200 mm 3 with left shift. Blood cultures drawn from the Cordis line, two arterial lines, and blood were all positive for O. anthropi, formerly known as Achromobacter species (CDC group Vd). The Cordis and arterial catheters were removed but
From the infectious Disease Division and the Department of Pathology, Winthrop~University Hospital, Mineola, and the State University of New York School of Medicine, Stony Brook. Reprint requests: Burke A. Cunha, MD, Chief, Infectious Disease Division, Winthrop~University Hospital, Mineola, NY i 1501. Copyright © i997 by Mosby-Year Book, Inc. 0i47~9563/97/$5.00+0 2/1179402
HEART & LUNG
VOL. 26, NO. 4
not cultured. Blood cultures I day later were negative. Although he did not receive any antibiotics, his temperature and WBC count normalized 4 days later, and he made an uneventful recovery. Bacteria, formerly belonging to the genus Achromobaeter aerobic gram-negative b a c i l l i - motile by peritrichous flagella, oxidase posit i v e - p r o d u c e acid oxidatively from carbohydrates and fail to produce 3~ketolactose.~ Strains with these characteristics were further divided i n t o A. xylosoxidans, w h i c h c o n t a i n e d two b i o t y p e s a n d an u n n a m e d s p e c i e s r e f e r r e d to a s g r o u p Vd b y t h e CDC. M e m b e r s of t h e Vd g r o u p , o r i g i n a l l y c o n s i s t i n g of two b i o t y p e s b u t l a t e r c o n s o l i d a t e d , can b e p r i m a r i l y d i f f e r e n t i a t e d from t h e f o r m e r b y t h e a b i l i t y to h y d r o l y z e u r e a a n d t h e f a i l u r e t o g r o w on c e t r i m i d e agar. 3 R e c e n t t a x o n o m i c s t u d i e s h a v e l e d t o t h e r e c l a s s i f i c a t i o n of t h e g r o u p Vd o r g a n i s m s w i t h i n t h e n e w g e n u s
Ochrobactrum. 4 Our isolate matched the mucoid variants d e s c r i b e d a s p i n p o i n t in s i z e a f t e r 24 h o u r s incu~ b a t i o n a t 35 ° C on M a c C o n k e y agar, with a m u c o i d c o l o n y 0.5 to 2.25 m m in d i a m e t e r a f t e r 48 hours. 3 T h e a n t i b i o t i c s u s c e p t i b i l i t y of our i s o l a t e was con*
sistent with most published case reports, 58 i.e., resistance to penicillins and cephalosporins, with susceptibility to trimethoprim*sulfamethoxazole and imipenem. O. anthropi appears to be an infrequent but widely distributed opportunistic pathogen, occur335
~'
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ring in b l o o d , r e s p i r a t o r y tract s p e c i m e n s , urine, feces, w o u n d s , ears, abscesses, a n d e v e n in h o s p i t a l a p p a r a t u s a n d e n v i r o n m e n t a l sources. 4 O. anthropi i n t r a v e n o u s - l i n e s e p s i s has b e e n r e p o r t e d in i m m u n o c o m p r o m i s e d a n d i m m u n o c o m p e t e n t hosts, a n d m o s t h a v e b e e n successf u l l y t r e a t e d w i t h a n t i b i o t i c s . 9"1~ A few cases of O. anthropi b a c t e r e m i a h a v e o c c u r r e d as t h e r e s u l t of contaminated infusion products. Clinically, our patient had intravenous-line sepsis due to O. anthropi, a n d t h e p a t i e n t r e c o v e r e d after r e m o v a l of t h e catheter.
REFERENCES 1. Tatum HW, Ewing WH, Weaver RE. Miscellaneous gram-negative bacteria. In: Lennette EH, Spaulding FH, Truant JP, editors. Manual of clinical microbiology. 2nd ed. Washington, DC, American Society for Microbiology; 1974.p. 270-94. 2. Weaver RE, Tatum HW, Hollis, DG. The identification of unusual pathogenic gram-negative bacteria (Elizabeth O. King). Atlanta: Centers for Disease Control; 1972.
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3. Chester B, Cooper LH. Achromobacter species (CDC group Vd): morphological and biochemical characterization. I Clin Microbiol 1979;9:42%36. 4. Holmes B, Popoff M, Kiredjian M, KerstersK. Oehromobaetrum anthropi gen nov sp nov from human clinical specimens and previously known as group Vd. lnt J Syst Bacteriol 1988; 38:404-10. 5. Barson WJ, Cromer BA, Marcon MJ. Puncture wound osteochondritis of the foot caused by CDC group Vd. ] Clin Microbiol 1987;25:2014-6. 6. Kish MA, Buggy PB, Forbes BA. Bacteremia caused by Aehromobaeter species in an immunocompromised host. l Clin Microbiol 1984;19:947-8. 7. Appelbaum PC, Campbell DB. Pancreatic abscess associated with Achromobactergroup Vd biovar 1. I Clin Microbiol 1980; 12:282-3. 8. Van Horn KG, Gedris CA, Ahmed T, Wormser GP. Bacteremia and urinary tract infection associated with CDC group Vd biovar 2. J Clin Microbiol 1989;27:201-2.' 9. Cieslak TJ, Robb ML, Drabick C J, Fischer GW. Catheter-associated sepsis caused by Oehromobaetrumanthropi: report of a case and review of related nonfermentative bacteria. Clin Infect Dis 1992;14:902-7. 10. Gransden WR, Eykyn SI. Seven cases of bacteremia due to Ochromobaeterium anthropi. Clin infect Dis 1992; 15:1068-9.
11. Gill MV, Klein NC, Cunha BA. Unusual organisms causing intravenous line infections in compromised hosts; I: bacterial and algal infections. Infect Dis Clin Pract 1996;5:244-55.
BOUND VOLUMES AVAILABLE TO SUBSCRIBERS Bound volumes of Heart & Lung ® are available to subscribers (only) for the 1997 issues from the Publisher at a cost of $30.00 for domestic, $38.52 for Canadian, and $36.00 for international subscribers for Vol. 26 (January-December)~ Shipping charges are included. Each bound volume contains a subject and an author index and all advertising is removed. Copies are shipped within 60 days after publication of the last issue in the volume. The binding is durable buckram with the Journal name, volume number, and year stamped in gold on the spine. Payment must accompany all orders. Contact Mosby-Year Book, Inc., Subscription Services, 11830 Westline Industrial Dr., St. Louis, M O 63146-3318, USA; phone (800)453-4351 or (314)453-4351.
Subscriptions must be in force to qualify. Bound volumes are not available in place of regular Journal subscription.
336
JULY/AUGUST1997 HEART & LUNG