Acetobacter indonesiensis Pneumonia after Lung Transplant

Mediterranean spotted fever in liver trans-plantation: a case report. To the Editor: Unusual and multiresistant bacterial infections are increasingly reported in cystic fi bro-sis (CF) patients (1). On January 25, 2007, a 31-year-old man with CF (mutation ΔF 508 and I 507) was admitted to our institution in Marseille, France, for lung transplantation. His immuno-suppressive regimen included IV cy-closporin A (for the fi rst 6 days with conversion to oral tacrolimus thereafter), azathioprine, and corticosteroids. Induction therapy that used antithy-mocyte globulin was administered for the fi rst 3 days (Thymoglobuline, Genzyme Corporation, Naarden, the Netherlands). Since 2003, the patient was chronically colonized by methi-cillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa (susceptible only to colistin sulfo-methate), and Candida albicans. Pre-emptive treatment with antimicrobial agents including colistin sulfomethate, tobramycin sulfate, ceftazidime, and linezolid was administered, starting on posttransplant day 1; prophylactic caspofungin, followed by inhaled am-photericin B, was given for the fi rst month. Six and 9 days, respectively, after surgery, sputa from the patient showed P. aeruginosa and MRSA. On postoperative day 11, the pa-tient's clinical condition worsened. Leukocytes increased to 13.84 × 10 9 /L. In addition to P. aeruginosa (10 4 CFU/mL) and MRSA (10 3 CFU/ mL), culture of later sputum samples yielded the growth of 10 4 CFU/mL of gram-negative, catalase-positive, and oxidase-negative bacillus (isolate 7120034) on CEPACIA agar (AES, Combourg, France) after 72 hours of incubation at 30°C. API 20NE, API 20E, and VITEK 2 Auto system (bio-Mérieux, Marcy l'Etoile, France) did not identify the bacillus. This bacterium was multiresistant to antimicrobial agents, including colistin, and was susceptible only to imipenem, rifampin, and aminoglycosides. The fi nal iden-tifi cation of this isolate as Acetobacter indonesiensis was achieved after partial sequencing of 16S rRNA gene, as previously described (2) (GenBank accession no. AJ199841, 99% similarity). The sequence of our isolate has been deposited in GenBank under the accession no. EF681860. The phylo-genetic position of isolate 7120034 among other gram-negative bacteria is shown in the Figure. Tobramycin was stopped at day 11, colistin and ceftazidime were stopped at postoperative day 14, lin-Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 6, June 2008 997 Figure. Phylogenetic tree showing the position of Acetobacter indonesiensis (isolate 7120034, GenBank accession no. EF681860), in boldface, within acetic acid bacteria and other gram-negative rods. The tree was based on 16S rDNA comparison by the neighbor-joining method. Numbers along the branches indicate bootstrap values.