We report for the first time a case of bacteremia caused by Comamonas kerstersii in a 65-year-old patient with sign of diverticulosis. In addition, we review the isolation of Comamonas sp. and related organisms in our hospital over 25 years. CASE REPORTC omamonas kerstersii is a nonfermenting betaproteobacterium described in 2003 that has long been considered nonpathogenic (1). This organism has recently been associated with intraabdominal infection due to perforation of the digestive tract (2). Here we describe a case of polymicrobial bacteremia due to C. kerstersii and Bacteroides fragilis in a 65-year-old diabetic man who was admitted to the emergency department of a hospital because of the sudden onset of fever and chills. The patient reported episodes of vomiting and diarrhea and mentioned that he had drunk water from a small river. Stool cultures performed after the beginning of antibiotic treatment did not disclose Salmonella, Shigella, Aeromonas, Campylobacter species, or C. kerstersii. The detection of Clostridium difficile toxins A and B and glutamate dehydrogenase antigen with the commercial C. difficile detection kit from Techlab was also negative. Blood samples (two pairs of culture bottles) were drawn from a peripheral vein, and the patient was discharged under treatment with oral ciprofloxacin for gastroenteritis of unknown origin. The blood cultures were processed by a Bactec FX automated blood culture system (Becton, Dickinson, Sparks, MD). A first aerobic blood culture bottle became positive 16 h 8 min after sampling, and Gram staining revealed the presence of long, filamentous, Gram-negative bacilli (Fig. 1). Bacterial identification by matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (Bruker Daltonics GmbH, Leipzig, Germany) was performed on the same day by using a protocol that we recently developed on the basis of the analyses of a bacterial pellet preparation from the blood culture bottles (3-5). The strain was identified as C. kerstersii, a Gram-negative nonfermenting bacterium, and prompted the hospitalization of the patient. The patient was afebrile at that time, but palpation of the left lower abdominal quadrant was painful. An abdominal computed tomography (CT) scan revealed diverticulosis without evidence of diverticulitis. The anaerobic blood culture bottles from the same pair of samples became positive for Bacteroides fragilis 24 h 2 min after sample collection. We determined the following MICs (mg/liter) for the C. kerstersii strain by the Etest method

We evaluated the outcome of multimodal supervised exercise training (SET) on walking performances and different hemodynamic parameters (ankle/toe-brachial index [ABI/TBI], and transcutaneous oxygen pressure [TcPO2]) in patients with symptomatic lower extremity peripheral artery disease (PAD). Whether hemodynamic parameters predict walking performances at baseline and following SET was also investigated. Fontaine stage II PAD’s patients following a 3-month SET were retrospectively included. Hemodynamic parameters and walking performances (pain-free [PFWD], maximal [MWD], and 6-minute [6MWD] walking distance) were measured in each patient. Eighty-five symptomatic PAD patients were included. Following SET, PFWD, MWD, and 6MWD significantly increased (+142%, +94%, +14%; respectively; P ≤ .001). Toe-brachial index significantly increased (MD: 0.04 ± 0.01; P = .02), whereas ABI and TcPO2 did not change significantly. At baseline, patients with higher TBI and TcPO2 performed significantly better (PFWD: β = 0.25, P = .01 for TBI; PFWD: β = 0.30, P = .005, and MWD: β = 0.22, P = .04, for TcPO2). No significant relationship was observed at baseline between ABI and walking performances. Baseline values of hemodynamic parameters did not significantly correlate with changes in walking performances. Multimodal SET significantly improves walking performances. Following SET, no significant changes in ABI and TcPO2 were observed. Toe-brachial index values significantly improved after SET. However, this increase was very modest and its clinical relevance remains questionable. Although baseline TBI and supine TcPO2 values predict baseline walking performances, no association was found between baseline hemodynamic parameters and changes in walking performances following SET.

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This study aimed to evaluate the effect of a multimodal supervised exercise training (SET) program on walking performance for 12 months in patients with symptomatic lower extremity peripheral artery disease (PAD). Consecutive patients with Fontaine stage II PAD participating in the SET program of our hospital were retrospectively investigated. Walking performance, assessed using a treadmill with measures of the pain-free and maximal walking distance (PFWD, MWD, respectively), and 6 min walking distance (6MWD), were tested before and following SET, as well as at 6 and 12 months after SET completion. Ninety-three symptomatic patients with PAD (65.0 ± 1.1 y) were included in the study. Following SET, the walking performance significantly improved (PFWD: +145%, p ≤ 0.001; MWD: +97%, p ≤ 0.001; 6MWD: +15%, p ≤ 0.001). At 6 months, PFWD (+257%, p ≤ 0.001), MWD (+132%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-SET condition. At 12 months, PFWD (+272%, p ≤ 0.001), MWD (+130%, p ≤ 0.001), and 6MWD (+11%, p ≤ 0.001) remained significantly improved compared with the pre-training condition. The walking performance remained significantly improved in both women and men for up to 12 months (p ≤ 0.001). Multimodal SET is effective at improving walking performance in symptomatic patients with PAD, with improvements lasting up to 12 months.