We describe what we believe to be the first case of biliary sepsis caused by Acinetobacter ursingii. The patient was a healthy woman with no comorbidities who presented with choledocholithiasis and cholangitis. The performance of an endoscopic cholangiopancreatography was the trigger for A. ursingii bacteraemia. This report highlights the inadequacies of conventional phenotypic tests usually available in clinical microbiology laboratories for the identification of Acinetobacter species.
Case reportA 47-year-old woman was admitted to hospital with fever and ictericia. Twelve days earlier, she had undergone a cholecystectomy due to cholelithiasis. Seven days after surgery, an endoscopic retrograde cholangiopancreatography (ERCP) was performed because of cholestatic jaundice with suspicion of choledocholithiasis. The ERCP confirmed choledocholithiasis and cholangitis with abundant purulent exudate within the choledochus. An endoscopic sphincterotomy was performed. No samples were taken for culture and no microbiological studies were done at that time. Two days after the ERCP was performed, the patient was discharged from hospital, but 24 h later she had to be admitted again because of high fever. Three blood cultures were taken and therapy with cefotaxime was started.Blood samples were inoculated in aerobic and anaerobic blood culture vials (Bactec Plus; BD Diagnostics Systems). Two aerobic vials were positive and were subcultured on chocolate and 5 % horse blood agar plates (bioMérieux). After 24 h incubation, colonies were 1-1.5 mm in diameter, circular and convex. No haemolysis was produced on 5 % horse blood agar. The isolate was a strictly aerobic Gram-negative coccobacillus, with positive catalase and negative oxidase reactions. It did not grow on MacConkey agar (bioMérieux).Phenotypic identification was made using the NegCombo 36 panel MicroScan (Dade Behring) and the API 20 NE strip (bioMérieux) in accordance with the manufacturers' instructions. The strain was identified as Acinetobacter lwoffii. With API 20 NE, the percentage of identification obtained was 86.9 % (code no. 0040000). According to the MicroScan system database, the only identification obtained was A. lwoffii (biotype 00000400).Antimicrobial susceptibility of the isolate was determined using the NegCombo 36 panel (MicroScan). The strain was resistant to cephalotin and cephazolin (MIC .16 mg ml 21 ), and susceptible to ampicillin (MIC ¡8 mg ml 21 ), amoxicillin-clavulanate (MIC ¡8 mg ml 21 ), cefuroxime (MIC ¡4 mg ml 21 ), cefoxitin (MIC ¡8 mg ml 21 ), cefotaxime (MIC54 mg ml 21 ), ceftazidime (MIC ¡1 mg ml 21 ), cefepime (MIC54 mg ml 21 ), imipenem (MIC ¡2 mg ml 21 ), aztreonam (MIC ¡1 mg ml 21 ), ciprofloxacin (MIC51 mg ml 21 ) and aminoglycosides (MIC ¡4 mg ml 21 ).For genotypic identification, the isolate was sent to the Microbiology National Center (Instituto de Salud Carlos III, Madrid, Spain) to determine the 16S rRNA gene sequence. A total of 1477 bp of 16S rRNA was determined using a method previously described (Drancourt et al., 200...
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