Comamonas kerstersii and the Perforated Appendix

Abstract

We read with interest two recent reports of Comamonas kerstersii-related infections in the abdomen (1) and bloodstream (2). We wish to add our own experience with C. kerstersii-related abdominal infections.Case 1. A 10-year-old boy presented with a 1-day history of abdominal pain. Examination revealed peritonitis in the right iliac fossa. On admission, his white blood cell count was 10.3 ϫ10 9 / liter and his C-reactive protein level was 228 mg/liter. A diagnosis of appendicitis was made, and an open appendectomy revealed a perforated appendix. Microscopic examination of peritoneal pus showed small numbers of Gram-negative bacilli that were plated onto Columbia blood agar (Oxoid), chocolate agar (Oxoid), and fastidious anaerobic agar with blood (Oxoid). After 48 h of incubation at 36°C in ambient air, colonies on the blood agar plate were identified by matrix-assisted laser desorption ionizationtime of flight (MALDI-TOF) mass spectrometry (Bruker) as C. kerstersii and a fine growth on the anaerobic plate was identified by MALDI-TOF as Streptococcus constellatus. These were the only organisms isolated. Postoperatively, the patient received piperacillin-tazobactam for 5 days and was discharged on amoxicillinclavulanic acid and ciprofloxacin, making a full recovery.Case 2. A 9-year-old boy presented with a 3-day history of right-sided constant abdominal pain associated with pyrexia. Examination revealed a tender right iliac fossa with localized peritonitis. On admission, his white blood cell count was measured at 13.6 ϫ10 9 /liter and his C-reactive protein level was 65 mg/liter. He developed septic shock and underwent emergency surgery, during which a perforated appendix was resected. Microscopic analysis of intraoperative peritoneal pus and an operative swab of the perforated appendix showed numerous pus cells but no organisms. After 48 h of incubation (as detailed above), the peritoneal fluid grew S. constellatus, Bacteroides fragilis, and C. kerstersii, as identified by MALDI-TOF, and the appendix swab revealed a pure growth of C. kerstersii. The patient received 3 days of intravenous amoxicillin-clavulanic acid, gentamicin, and metronidazole and was discharged on oral amoxicillin-clavulanic acid. He made a full recovery.C. kerstersii, which has undergone extensive reclassification (3, 4), was isolated from our patients as part of a polymicrobial growth from peritoneal fluid. MALDI-TOF appeared to be a reliable tool for identifying these organisms. In case 1, C. kerstersii was identified with a score of 2.275, followed by Comamonas testosteroni (1.664) and Comamonas aquatica (1.579), and in case two, C. kerstersii was identified with a score of 2.294, followed by C. aquatica (1.585), Brenneria nigrifluens (1.299), and C. testosteroni (1.222). The antibiotic sensitivities of the isolates obtained are shown in Table 1. In addition, disc diffusion testing of the isolate from case 2 for amoxicillin-clavulanic acid showed a large zone of Ͼ25 mm, suggesting sensitivity, and the use of amoxicillin-clavulanic acid resu...

Difficulties in Identification of Сomamonas Kerstersii Strains Isolated From Intestinal Microbiota of Residents of Republic of Guinea and Russian Federation

“…The data of a few foreign studies of the antimicrobial susceptibility testing of C. kerstersii strains do not allow comparison of the results, as some authors used a disc-diffusion method (not recommended by CLSI) for testing these microorganisms [8] or testing using other interpretation criteria [4,5]. Nevertheless, the MIC results allow us to conclude that resistance to fluoroquinolones, trimethoprim/ sulfamethoxazole and amikacin was noted among C. kerstersii strains isolated at different times [4,5,17].…”

“…In the UK for two years, C. kerstersii were isolated from 27 hospitalized patients with diarrhea. The authors suggested that the carriage of this microorganism in the intestine can occur more often than was previously thought, since modern identification methods were not available [8].…”

“…As the databases expand, the identification capacity of the methods will include a wider range of microorganisms, and other types of Сomamonas. Publications about etiological significance of C. kerstersii appeared shortly after the method of Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) mass spectrometry was used to identify microorganisms in bacteriological laboratories and the reliability of the identification results was confirmed by molecular genetic methods [4,5,8,17].…”

Moderation effects of food intake on the relationship between urinary microbiota and urinary interleukin-8 in female type 2 diabetic patients

“…The current literatures supported that Comamonas spp. was related to infections including phlegmon, peritonitis, endocarditis, meningitis, septicemia and UTI (Cooper et al, 2005;Biswas, Fitchett & O'Hara, 2014;Horowitz et al, 1990). Barua et al (2017) found that nephritic syndrome patients with higher serum cholesterol were more susceptible to UTI than those with normal serum cholesterol, which might be because high cholesterol concentrations suppress lymphocyte function.…”

Peer Review #2 of "Moderation effects of food intake on the relationship between urinary microbiota and urinary interleukin-8 in female type 2 diabetic patients (v0.1)"

“…The current literatures supported that Comamonas spp. was related to infections including phlegmon, peritonitis, endocarditis, meningitis, septicemia, and UTI (Cooper et al, 2005;Biswas et al, 2014;Horowitz et al, 1990). Barua et al found that nephritic syndrome patients with higher serum cholesterol were more susceptible to UTI than those with normal serum cholesterol, which might be because high cholesterol concentrations suppress lymphocyte function (Barua et al, 2016 Manuscript to be reviewed (Rochelson et al, 2007;Weglicki et al, 1992), and a previous rodent model study demonstrated that magenesium-deficiency elevated circulating levels of inflammatory cytokines (Weglicki et al, 1992).…”