We describe a patient with a urinary tract infection (UTI) caused by Pasteurella multocida. Pulsed-field gel electrophoresis revealed that the clinical isolate recovered from the patient was identical (100% band match) to P. multocida isolates recovered from the patient's cat, but the isolate differed from an isolate recovered from a visiting cat and from a laboratory control strain. The patient also had abnormal urologic anatomy secondary to surgery; this has also been associated with P. multocida UTI.

We report a novel anaerobe causing abscess in four patients at three hospitals. In the clinical specimen, bacilli were branching, Gram positive, and acid fast. The organism grew slowly and was not identified by 16S rRNA sequencing. Our findings support the description of a new genus and species of the suborder Corynebacterineae. CASE REPORTSC ase 1. A 65-year-old male with metastatic prostate cancer diagnosed in Cleveland, OH, in March 2009 presented 1 June 2011 with an enlarging mass adjacent to a surgical incision at T3-8 from previous spinal stabilization at the time of diagnosis. Medications included prednisone (5 mg daily), docetaxel, zoledronic acid, and leuprolide. There was no significant travel history, exposure to animals, or sick contacts. He denied trauma to the upper back and had a sedentary life. A physical exam revealed a weight of 130 kg, blood pressure of 106/78, pulse of 160/min (atrial fibrillation), temperature of 38.6°C, and respiratory rate of 22/min. He was unaware of his fever. The mass was minimally warm to the touch, mildly erythematous, fluctuant, nondraining, and nonpainful. The white blood cell (WBC) count was 12,370/l with 77% neutrophils.The magnetic resonance imaging (MRI) and computed tomography (CT) scan were consistent with thoracic fluid collection and abscess. Surgical incision and drainage produced a large amount of purulent, nonodorous fluid. Pedicle screws placed previously were solidly in position, and there was no evidence of bony destruction. Partial hardware removal and debridement of necrotic tissue were performed. A swab of the subfascial tissue, fluid, and hardware were submitted for culture. A beaded Gram-positive, branching bacillus and inflammatory cells were present on Gram stains of all material submitted. Modified Kinyoun stain was positive. (Fig. 1a and b).Vancomycin started prior to surgery was switched to ampicillin-sulbactam but changed to meropenem due to suspicion of Nocardia. Blood cultures produced no growth. The white blood cell count normalized, and he was afebrile by postoperative day 2. His surgical site healed well, and he was discharged postoperative day 7 on meropenem. After 4 weeks, home antibiotic therapy was switched to sulfamethoxazole-trimethoprim (SXT) at 800 to 160 mg with two tablets 3 times per day (TID). Docetaxel chemotherapy was resumed.Anaerobic cultures of the fluid and hardware grew after 13 days of incubation. Cultures performed from swabs of tissue did not grow, nor was growth obtained from any specimen submitted for culture for mycobacteria, fungi, and aerobic bacteria. By partial 16S rRNA sequencing, the organism was Ͻ95% identical to Dietzia, Tsukamurella, and Corynebacterium spp. The 16S rRNA sequence (1,445 bp) was later submitted to GenBank. With these results, therapy was changed to amoxicillin-clavulanate (1,000/ 62.5 mg twice daily).Five weeks postoperatively, a scant amount of clear yellow nonodorous fluid was noted draining from a pinhole-sized opening of a 3-cm fluctuant, nonerythematous collection at the surgical si...

We evaluated stool specimens known to contain or be free ofCampylobacter by traditional culture, using the ProSpecTCampylobacter microplate assay (Alexon-Trend, Ramsey, Minn.). This rapid enzyme immunoassay for the detection ofCampylobacter-specific antigens demonstrated 96% sensitivity and 99% specificity and is an acceptable alternative method of Campylobacter detection.

The accuracy of Vitek MS mass spectrometric identifications was assessed for 206 clinically significant isolates of aerobic Grampositive bacilli representing 20 genera and 38 species. The Vitek MS identifications were correct for 85% of the isolates (56.3% to the species level, 28.6% limited to the genus level), with misidentifications occurring for 7.3% of the isolates. I dentification of aerobic, Gram-positive bacilli (GPB) to the species level is challenging. Biochemical methods are slow and labor-intensive and may not provide reliable results. Molecular sequencing techniques have become the gold standard for identification of GPB (1-3) but are too expensive for routine use by the clinical microbiology laboratory. As a consequence, GPB identifications are often limited to the genus level or descriptive results (e.g., diphtheroid).Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is a new technology offering accurate, fast, and affordable identification for bacteria and yeasts (4-7). Mass spectrometry results are graphed as peaks based on the mass/charge ratio of microbial proteins that have been ionized from intact cells obtained from pure culture. Identification is achieved by comparison of the mass spectral profile to a reference database.The purpose of this study was to evaluate the accuracy of MALDI-TOF MS identifications generated by the Vitek MS system (v2.0; bioMérieux, Durham, NC) for aerobic GPB isolates commonly encountered in the clinical microbiology laboratory. The Vitek MS results were compared to identifications previously reported that were based on conventional biochemical or molecular methods. Sequencing of 16S rRNA or rpoB genes was performed to arbitrate discordant results. Although the Vitek MS system recently received FDA 510(k) de novo clearance, only a few of the species analyzed in this current study were included in the FDA clinical trials and data submission.A total of 206 GPB isolates recovered from specimens submitted for culture from 31 December 2007 to 21 August 2012 were selected from the frozen stock database of the Cleveland Clinic Clinical Microbiology Laboratory for inclusion in the study. Duplicate isolates of the same species from a single patient were excluded. Approval was received by the institutional review board prior to initiation of the study. These clinical isolates had been previously identified using biochemical testing or molecular methods (sequencing of 16S rRNA or rpoB genes). The frozen isolates were plated on 5% sheep blood agar and incubated overnight at 35°C in 5% CO 2 . Isolates were subcultured a second time before Vitek MS testing was performed. The manufacturer's instructions were followed for Vitek MS testing.A thin film of fresh colony growth was applied directly to the target slide. Each spot was covered with 1 l of matrix solution (␣-cyano-4-hydroxycinnamic acid; bioMérieux), allowed to dry, and analyzed on the Vitek MS instrument. If two attempts at direct colony testing failed to provide an acceptable si...

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