This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

Samples for blood culture should be obtained through all catheter lumens to establish a diagnosis of CRBSI.

Phenotypic tests do not always unequivocally identify some species of viridans group streptococci (VGS). sodA sequence analysis is the most accurate method for identification, although it requires specialized personnel and has not been applied systematically in clinical microbiology laboratory routines. Matrix‐assisted laser desorption ionization‐time of flight (MALDI‐TOF) is emerging as a rapid alternative for bacterial identification. This study assesses the ability of MALDI‐TOF and the API 20 Strep system to identify VGS isolates recovered from blood cultures using sodA sequence analysis as the reference method. All clinically significant VGS isolates recovered from blood cultures between January 2007 and January 2010 were identified by sodA sequence analysis and API 20 Strep. The strains were then tested by MALDI‐TOF. Agreement between API 20 Strep/MALDI‐TOF and sodA sequence analysis was determined. We examined 124 clinical isolates. Sensitivities of API 20 strep and MALDI‐TOF for the species level identification of VGS isolates were, respectively, as follows: 60.5% and 73.4%. Sensitivities of API 20 strep and MALDI‐TOF for the group level identification were, respectively, as follows: 70% and 94.3%. The turnaround times to identify VGS isolates by sodA sequence analysis, API 20 Strep and MALDI‐TOF were 12–24, 24–48 h and 15 min, respectively. API 20 Strep cannot accurately identify all isolates of VGS. MALDI‐TOF appeared to be a rapid and reliable alternative for identification of VGS strains to group level, but was not able to discriminate closely related species of certain groups.

Las infecciones por Cupriavidus spp. son poco frecuentes, especialmente en niños, causando infecciones en inmunodeprimidos o portadores de dispositivos intravasculares. Objetivo: Presentar un caso de bacteriemia recurrente relacionada con catéter por Cupriavidus pauculus en un paciente pediátrico para analizar posibles opciones terapéuticas, especialmente en relación con la necesidad o no de retirada de catéter venoso central (CVC). Caso Clínico: Niño de 22 meses con leucemia linfoblástica aguda (LLA) tipo B en fase de reinducción, portador de un CVC. Consultó en Servicio de Urgencias por fiebre sin foco, sin elevación de reactantes de fase aguda. Se hospitalizó con antibioterapia intravenosa empírica con cefalosporina de 4ª generación (cefepime). En los hemocultivos diferenciales (sangre periférica y CVC) se identificó Cupriavidus pauculus, creciendo primero en el cultivo del CVC. Se mantuvo antibioterapia sistémica sin cambios y se iniciaron sellados del catéter con ciprofloxacino. La evolución fue favorable, resolviéndose la infección y permitiendo conservar el catéter. Siete meses después el paciente presentó otro episodio de fiebre sin foco, aislándose nuevamente Cupriavidus pauculus en el hemocultivo del CVC. En esta ocasión, además de cefepime intravenoso, se decidió retirar el CVC. Tras 9 meses de la retirada del CVC, no ha presentado nuevos episodios. Conclusión: Las infecciones por Cupriavidus spp. son raras en pediatría. El tratamiento sistémico asociado a sellados del CVC podría ser una opción segura en pacientes estables con dificultad para la retirada del catéter; aunque, ante la sospecha de colonización persistente del catéter, puede ser necesaria su retirada.