Insight into Kytococcus schroeteri Infection Management: A Case Report and Review

Abstract

Background: Kytococcus schroeteri is a member of normal skin microflora, which can cause lethal infections in immunosuppressed hosts. In this review we attempted to draw patterns of its pathogenicity, which seem to vary regarding host immune status and the presence of implantable devices. Evidence suggests this pathogen houses many resistance-forming proteins, which serve to exacerbate the challenge in curing it. Available information on K. schroeteri antibacterial susceptibility is scarce. In this situation, a novel, genome-based antibiotic resistance analysis model, previously suggested by Su et al., could aid clinicians dealing with unknown infections. In this study we merged data from observed antibiotic resistance patterns with resistance data demonstrated by DNA sequences. Methods: We reviewed all available articles and reports on K. schroeteri, from peer-reviewed online databases (ClinicalKey, PMC, Scopus and WebOfScience). Information on patients was then subdivided into patient profiles and tabulated independently. We later performed K. schroeteri genome sequence analysis for resistance proteins to understand the trends K. schroeteri exhibits. Results: K. schroeteri is resistant to beta-lactams, macrolides and clindamycin. It is susceptible to aminoglycosides, tetracyclines and rifampicin. We combined data from the literature review and sequence analysis and found evidence for the existence of PBP, PBP-2A and efflux pumps as likely determinants of K. schroeteri. Conclusions: Reviewing the data permits the speculation that baseline immune status plays a role in the outcome of a Kytococcal infection. Nonetheless, our case report demonstrates that the outcome of a lower baseline immunity could still be favorable, possibly using rifampicin in first-line treatment of infection caused by K. schroeteri.

A case of Kytococcus schroeteri prosthetic valve endocarditis in a patient with COVID-19 infection

“…Unavailability of MALDITOF/PCR or whole genome sequencing technologies may lead to underreporting. Treatment for Kytococcus schroeteri also poses challenges as it a relatively slow growing bacteria, antimicrobial resistance and unavailability of standard susceptibility breakpoints [ 2 , 4 ]. Breakpoint of staphylococcus are used to interpret susceptibility as per other case reports [ 4 ].…”

“…Bagelman, S et al. [ 4 ] in his systematic review of publications in the last 17 years has reviewing 22 cases. Reported cases have mostly been infections of prosthetic valves [ 5 , 6 , 9 , 10 ] cardiac implantable electronic devices (CIED) [ 11 ]/rheumatic valvular heart disease.…”

“…Reported cases have mostly been infections of prosthetic valves [ 5 , 6 , 9 , 10 ] cardiac implantable electronic devices (CIED) [ 11 ]/rheumatic valvular heart disease. Additionally Central venous catheters [ 12 ]/chemotherapy port infections in immunocompromised patients leading to bacteremia and pneumonia have been described [ 4 , 12 ]. Orthopedic infections including spondylodiscitis [ 13 ], artificial silicon tendon tissue infections, infections of intra medullary nails chronic osteomyelitis [ [14] , [15] ].…”

“…The review of literature by Shelly Bagelman et al. [ 4 ] alludes that six patients out of eight patients who were reviewed, were immunocompromised and had developed pneumonia and bacteremia succumbed to the infection. All eight patients with endocarditis and three patients with orthopedic infections recovered.…”

“…Another challenge in treating kytococcus as lack of data on antimicrobial susceptibility and absence of susceptibility breakpoints. Most studies have used staphylococcal breakpoint as reference as specific breakpoints are not available [ 4 , 13 , 14 ]. These isolates are resistant to penicillin unlike Micrococcus.…”