A Cluster of Rhodococcus (Gordona) Bronchialis Sternal-Wound Infections after Coronary-Artery Bypass Surgery

Richet, Hervé; Craven, Philip C.; Brown, June M.; Lasker, Brent A.; Cox, Candice D.; McNeil, Michael M.; Tice, Alan D.; Jarvis, William R.; Tablan, Ofelia C.

doi:10.1056/nejm199101103240206

Cited by 111 publications

(66 citation statements)

References 28 publications

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“…G. bronchialis has been reported to date only in a case of bacteremia in a patient with a sequestrated lung (11) and in sternal wound infections after coronary artery bypass surgery (9).…”

Section: Case Reportmentioning

confidence: 99%

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Recurrent Breast Abscess Caused by Gordonia bronchialis in an Immunocompetent Patient

et al. 2005

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We present the first reported case of a recurrent breast infection caused by Gordonia bronchialis. The infection occurred in a 43-year-old immunocompetent female, and species level identification was obtained with 16S rRNA sequencing. CASE REPORTA 43-year-old female presented to hospital with a 4-day history of a tender mass in her left breast. On examination, there was marked fullness with erythema on the lateral aspect of the left breast extending to the areola and a palpable mass measuring 4 to 5 cm in diameter. Ultrasonic examination showed an extensive area of inflammatory changes but no abscess formation. There was no mammographic evidence of malignancy. Microscopic examination of a core biopsy showed acute inflammatory changes and intra-and extracellular grampositive organisms. The peripheral white blood cell count remained normal, a human immunodeficiency virus antibody test was negative, and immunoglobulin levels were normal. The histological diagnosis was granulomatous mastitis with no evidence of malignancy.Intravenous penicillin and flucloxacillin therapy was started, but this was changed to oral amoxicillin-clavulanate and metronidazole after 3 days. A further 3 days later, she was discharged from hospital taking oral doxycycline (100 mg daily) and oral clindamycin (150 mg 4 times a day), which was continued for 12 days. In the following 2 weeks, the area of inflammation enlarged and an abscess formed, requiring readmission to hospital. The abscess was incised, and approximately 10 ml of purulent material was drained. At this stage, she was recommenced on doxycycline (200 mg daily). Two further drainage procedures were required, after which the skin healed and the induration resolved, leaving a small palpable lesion thought to be scar tissue. Antibiotic therapy was stopped after 5 months of continuous treatment, but within 2 weeks pain returned and the abscess reformed.Of note in the patient's past medical history is a pituitary adenoma with galactorrhea detected 3 years before. This has been controlled with cabergoline. There was no history of prior breast abscess, breast implants, trauma to the breast, or other conditions that might predispose to breast abscess formation.Dry, crinkled, creamy-white colonies were seen on culture of pus aspirated at the time the abscess was first incised. A Gram stain could not be performed at this time, as there was an insufficient amount of specimen available. Morphologically similar colonies were identified from a follow-up swab taken 5 days after the lesion was first incised and from a swab and aspirate taken a further 5 days later. On this occasion, grampositive cocci were seen in the aspirated material with microscopy. After the second incision and drainage, cultures of three further wound swabs and one tissue specimen all grew the previously isolated organism. Coagulase-negative staphylococci were coisolated from two of the samples, but no other microorganisms were cultured.Upon nonstandardized susceptibility testing by disk diffusion, the organism was found ...

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“…G. bronchialis has been reported to date only in a case of bacteremia in a patient with a sequestrated lung (11) and in sternal wound infections after coronary artery bypass surgery (9).…”

Section: Case Reportmentioning

confidence: 99%

“…The recurrence of infection with Gordonia species has been described previously (3,4,8), usually with subsequent clearance. More frequently, the infections were cleared only after prolonged antimicrobial treatment and surgical debridement where appropriate (2,6,8,9,10,11).…”

Section: Case Reportmentioning

confidence: 99%

Recurrent Breast Abscess Caused by Gordonia bronchialis in an Immunocompetent Patient

et al. 2005

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“…The PD catheter is removed 12 months or sooner after insertion in more than 10% of patients, and the most common reason for such removals is catheter-related infection (1). Prevention of such complications is therefore very important, and a recent guideline also emphasized the need for attention to detail in the reduction of complications (2).…”

Section: Impact Of the Inclusion Of A Nephrologist On The Surgical Tementioning

confidence: 99%

“…This slow-growing organism tends to form a biofilm that is difficult to eradicate. It is usually found in soil and has previously been isolated from human skin and the sputa of respiratory patients (1,2). Most published case studies show that Gordona causes infection in patients who are immunocompromised or have indwelling catheters.…”

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confidence: 99%

Gordona: A Rare Cause of Peritoneal Dialysis Peritonitis

et al. 2012

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“…Although G. bronchialis infection has been reported in sternal wounds following coronary artery bypass grafting (10), this species has not been known to cause septicemic infection. Our patient suffered from bacteremia with possible spread to previously inflamed lumbosacral vertebrae.…”

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confidence: 99%

Bacteremia Caused by Gordonia bronchialis in a Patient with Sequestrated Lung

Sng¹,

Koh²,

Toney

et al. 2004

J Clin Microbiol

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Gordonia species have been recognized as pathogens in immunocompromised and immunocompetent patients. We report the first case of bacteremia due to Gordonia bronchialis in a diabetic patient with a sequestrated lung. Species identification was confirmed with mycolic acid analysis by high-performance liquid chromatography and sequencing of the 16S rRNA gene.A 58-year-old woman with recently discovered diabetes mellitus, long-standing spondylolisthesis, and asthma presented with acute exacerbation of low back pain after an exercise session. Breathlessness, fever, and chills accompanied the pain. The patient had been treated for a pleural effusion and a loculated lung cyst with drainage 15 and 5 years previously, respectively. On physical examination, the patient was febrile with a reduced ability to raise and straighten her right leg and diminished deep tendon reflexes of the right lower limb. The patient's white cell count was elevated, at 15 ϫ 10 9 /liter, with a predominance of polymorphs (86%). Chest X-rays showed pneumonic-type lung consolidation, and consequently the patient was treated with ceftriaxone and clarithromycin for community-acquired pneumonia. Computer-assisted tomography of the thorax suggested a sequestrated lung.Subsequent magnetic resonance imaging of the lumbosacral spine showed a 5-mm air pocket with enhancement surrounding the lesion from L4 to S1. The antimicrobials with which the patient was treated were changed to cloxacillin for osteomyelitis and ceftazidime for possible infection with Burkholderia pseudomallei, which is endemic in the southeast Asia region. On the fifth day, blood cultures taken during admission and incubated in Bactec 9000 (Becton Dickinson, Cockeysville, Md.) were positive for growth. Haemophilus aphrophilus was isolated upon subculture on a blood agar plate and identified by using XV disks and the API NH (bioMérieux, Marcyl'Etoile, France) system. The isolate was found to be susceptible to ceftriaxone by the disk diffusion method. A transthoracic echocardiogram was normal. However, the patient's health did not improve and her neurological status deteriorated, with a loss of ankle reflex. A repeat scan of the lumbar spine demonstrated a subcortical mass at L3 to L4 with a left paravertebral abscess extending inferiorly to the gluteal region. Reincubation of the original blood agar plate for an additional 5 days revealed the presence of a second organism, which formed translucent, nonhemolytic, dry, wrinkled colonies within 24 h; these colonies became opaque, rough, and salmon colored at 72 h. Growth and pigmentation were demonstrated at 35°C with ambient air on Trypticase soy agar with sheep blood, chocolate agar, and brain heart infusion agar. The isolate was a beaded gram-positive bacillus which was weakly acid-fast. The microscopic appearance of the growth on a water agar plate showed symmetra and no aerial hyphae. Tests for lysozyme, casein, tyrosine, and xanthine hydrolysis were negative, while tests for urease and nitrate were positive after 48 h and a test fo...

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A Cluster of Rhodococcus (Gordona) Bronchialis Sternal-Wound Infections after Coronary-Artery Bypass Surgery

Cited by 111 publications

References 28 publications

Recurrent Breast Abscess Caused by Gordonia bronchialis in an Immunocompetent Patient

Recurrent Breast Abscess Caused by Gordonia bronchialis in an Immunocompetent Patient

Gordona: A Rare Cause of Peritoneal Dialysis Peritonitis

Bacteremia Caused by Gordonia bronchialis in a Patient with Sequestrated Lung

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