Fatal Nosocomial MDR TB Identified through Routine Genetic Analysis and Whole-Genome Sequencing
نویسندگان
چکیده
Empirically prescribed antimicrobial therapy (ceftazidime, colistin, amikacin, and metronidazole) was given for 96 hours and then replaced by gentamicin for 48 hours and amoxicillin for 3 weeks; clinical results were favorable. The isolate strain was analyzed by the Division of Bacterial Identification (Pasteur Institute, Paris, France). The 16S rRNA gene was completely sequenced. A phylogenetic tree was generated by using the neighbor-joining algorithm (3). The isolate was found be C. divergens. Microbiological cultures and 16S rRNA testing results for another sample of enteral nutrition solution and a surgical specimen of the necrotic esophagus were negative. Three reports of isolation of Carnobacterium sp. from humans have been published. The first report described isolation of Carnobacterium sp. from 1 set of blood cultures from a man who had prepared fish before onset of fever (4). The imputability of this diagnosis could not be clearly established because only 1 set of blood cultures had positive results. The second report described isolation of C. pi-scicola from pus after traumatic amputation of a hand by an industrial water sawmill (5). The third report described isolation from a child's hand with multibacterial synergistic gangrene (6). For the case described here, the presence of C. diver-gens in blood cultures cannot be considered contamination because it was isolated from 4 sets of blood cultures collected over 5 days. We hypothesize that bacterial transloca-tion was caused by low mesenteric flow after 2 episodes of cardiac arrest. Because the patient was receiving exclusively enteral nutrition, we presume that the origin of the infection was bacterial contamination of the solution or coloni-zation of the feeding tube. Carnobacteria and lactobacilli (which are used as probiotic bacteria or fermented food products) are similar in that each is found in food, can be used as a biopreservative, and is considered nonpathogenic. The pathogenic relevance of lactobacilli is uncommon, but some clinical infections have been reported, including sep-ticemia and meningitis (7). Because C. divergens seems to be able to cause life-threatening infection in immunocom-promised patients, its safe use in such patients and in the food industry should be monitored. 3. Saitou N, Nei M. The neighbor-joining method: a new method for reconstructing phylogenetic trees. et al. Isolation of Carnobacterium sp. from a human blood culture. et al. Etiological study for a case of multi-bacterial synergistic gangrene. To the Editor: In November 2012, a 44-year-old HIV-negative white man (patient 1) with fever, fatigue, and breathlessness sought …
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عنوان ژورنال:
دوره 21 شماره
صفحات -
تاریخ انتشار 2015