First Case of Pseudoclavibacter bifida Bacteremia in an Immunocompromised Host with Chronic Obstructive Pulmonary Disease (COPD)

Abstract

f Pseudoclavibacter spp. are Gram-positive, aerobic, catalase-positive, coryneform bacteria belonging to the family of Microbacteriaceae. Identification of these species with conventional biochemical assays is difficult. This case report of a Pseudoclavibacter bifida bacteremia occurring in an immunocompromised host diagnosed with an acute exacerbation of chronic obstructive pulmonary disease, with a lethal outcome, confirms that this organism may be a human pathogen. CASE REPORTA n 86-year-old male patient suffering from dyspnea, with severe respiratory distress and fever, was admitted to our hospital. In 2006, the patient was diagnosed with class I chronic obstructive pulmonary disease (COPD), for which he was receiving inhaled glucocorticoids and long-acting bronchodilators. COPD exacerbation with a left lobular pneumonia led to hospitalization in July 2011. Treatment with amoxicillin-clavulanic acid was initiated and switched to piperacillin-tazobactam due to respiratory insufficiency. Bronchial aspirates and blood cultures remained negative. Normalization of the lung function parameters and improvement in his general condition led to discharge from the hospital. Other relevant medical history comprised arrhythmia, renal failure, and diabetes mellitus type II.In September 2011, he presented with dyspnea and fever (body temperature, 38.4°C). No other significant symptoms could be elicited. The patient was hemodynamically stable. Hematological investigations revealed a white blood cell count of 33.4 ϫ 10 3 cells/l, with 96% neutrophils (reference range, 46 to 64%), a hemoglobin level of 10.3 g/dl (reference range, 12.6 to 17.4 g/dl), a hematocrit of 31.0% (reference range, 39.0 to 50.0%), and a platelet count of 245 ϫ 10 3 /l (reference range, 150 ϫ 10 3 to 450 ϫ 10 3 /l). The C-reactive protein level increased up to 29.5 mg/dl (normal, Ͻ1.0 mg/dl) 3 days after admission (initial value at admission, 20.1 mg/dl), and the serum creatinine level was 3.12 mg/dl (reference range, 0.70 to 1.30 mg/dl). The levels of D-dimers (1,906 ng/ml [reference range, Ͻ500 ng/nl]) and digoxin (3.35 g/liter [reference range, 0.80 to 2.00 g/liter]) were increased. An arterial blood gas examination revealed decreased pO 2 and pCO 2 levels of 60 mm Hg (reference range, 75 to 100 mm Hg) and 29.1 mm Hg (reference range, 30 to 48 mm Hg), respectively. A bedside chest X ray showed infiltrates in the left and right lobes, suggestive of bilateral pneumonia (Fig. 1).Before intravenous antibiotic treatment with ceftriaxone (2 g every 24 h) was initiated, two aerobic and two anaerobic blood culture bottles (Bactec; Becton, Dickinson, Sparks, MD) were collected at two different fever spikes. One pair was drawn through a catheter; another pair was drawn by peripheral venipuncture. After a mean incubation time of 52.4 h at 35°C, branched, rodshaped, whitish-grayish, nonfermentative Gram-positive bacteria were observed in both aerobic blood culture bottles. Further bacteriological investigation showed nonmotile, alkaline phosphatase-positive, cat...

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