Acetobacter cibinongensis Bacteremia in Human

Acetobacter cibinongensis Bacteremia in Human To the Editor: The genus Aceto-bacter belongs to the group of acetic acid bacteria that oxidize alcohols or sugars incompletely, leading to the accumulation of acetic acid. Acetic acid bacteria are of great industrial interest because of their use to produce vinegar from spirits, wine, beer, and cider in temperate regions of Europe, the Americas, and Japan. Several species seem to be associated with tropical climates. In Southeast Asia, Acetobacter spp. have been found in fermented foods such as tea fungus beverage, palm vinegar, palm wine, nata de coco, and pickles (1). A. cibinongensis is mainly found in tropical fruits and fl owers (2). We describe a case of human infection with a member of the genus Acetobacter. The patient was an HIV-serone-gative, 40-year-old man who for 1 year had been receiving chronic he-modialysis for end-stage renal failure. He had a history of intravenous drug use, and continued use was suspected. In February 2005, when admitted for a routine dialysis session, he had fever (38°C) and bronchitis and was receiving empiric treatment with amoxicil-lin (2 g/day). His respiratory status improved slightly, but fever persisted after 48 hours. On his right forearm, he had a large infl ammatory skin le-sion that followed the course of an arteriovenous fi stula, suggestive of staphylococcal infection. Treatment was switched to pristinamycin (2 g/ day for 4 days). The patient's leuko-cyte count was within normal limits, but his C-reactive protein level was elevated (50 mg/L). Two blood samples were drawn, 1 through a subcla-vian catheter implanted in 2004 and the other through the arteriovenous fi stula. After 4 days, a gram-variable polymorphic rod, named nîmes373, grew from both aerobic culture vials and yielded very small polymorphic colonies on Columbia sheep blood and blood-chocolate agar plates (Bio-Rad, Marnes-la-Coquette, France). Enhanced growth was observed on Legionella agar (AES Chemunex, Bruz, France) and on R2A agar plates (BD-BBL, Le Pont de Claix, France). Biotyping of this catalase-positive, oxidase-negative rod with API 20NE and API 20E strips (bioMérieux, Marcy l'Etiole, France) and with the ID-GNB card system on a VITEK 2 apparatus (bioMérieux) did not identify the bacterium. Positive reactions were obtained for acetoin production and citrate assimilation. Antimicro-bial drug–susceptibility pattern could not be validated owing to the lack of interassay reproducibility. Pristina-mycin was replaced by broad-spectrum antimicrobial therapy consisting of cefazolin (1 g every 48 hours) and tobramycin (225 mg after each hemo-dialysis …