Life-Threatening Mycoplasma hominis Mediastinitis

Mattila, Petri S.; Carlson, Petteri; Sivonen, Aulikki; Savola, Juha‐Matti; Luosto, R; Salo, Jarmo A.; Valtonen, Matti

doi:10.1086/313529

Cited by 44 publications

(31 citation statements)

References 36 publications

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“…In half of the cases, IE appeared in the first year following cardiac surgery, as reported in our case, suggesting possible nosocomial infection. Despite the fact that M. hominis nosocomial IE was never previously reported, M. hominis wound infections have been described after a caesarian procedure (15,16) and sternotomy and may be responsible for mediastinitis (17)(18)(19)(20)(21)(22). Eight cases of M. hominis mediastinitis (6 occurring after coronary artery bypass) were reported previously (21).…”

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confidence: 99%

Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

et al. 2015

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e Mycoplasma spp. are rarely recognized agents of infective endocarditis. We report a case of Mycoplasma hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA (rDNA) PCR and culture of valves in a 74-year-old man. We reviewed the literature and found only 8 other cases reported. CASE REPORTA 74-year-old man, with a history of hypertension and mitral and aortic biological prosthetic valve replacement since June 2013 and stroke in August 2013, was admitted in December 2013 to the intensive care unit of the University Hospital of Saint Etienne, Saint-Etienne, France, for dizziness and cardiac and kidney failure. Physical examination revealed a low-grade fever (38.2°C) and an aortic murmur. A first transthoracic echocardiography procedure showed a decrease in the left ventricular ejection function fraction (LVEF) to 35% compared to anterior data (LVEF, 45% to 50% in June 2013), whereas the prosthetic valves appeared functional. The results of a second transthoracic echocardiography procedure, performed only 2 days later, were consistent with aortic prosthetic endocarditis associated with grade IV aortic insufficiency, a decrease in the LVEF to 25%, and an abscess of mitroaortic intervalvular fibrosa. Four days later, 2 of 6 blood cultures grew with the same strain of Staphylococcus epidermidis after 19 and 23 h, respectively (blood culture system, Bactec FX40; Becton Dickinson). Both positive blood cultures were obtained through an arterial catheter. The results of peripheral blood cultures obtained through vein and central venous catheters remained negative. Diagnosis of infective endocarditis (IE) was based on Duke's criteria (1 major criterion [valvular abscess] and 3 minor criteria [fever over 38°C, blood culture positive for S. epidermidis, and predisposing heart condition, i.e., history of valvular replacement]). The initial antibiotic regimen included vancomycin (20 mg/kg of body weight/day) and linezolid (600 mg twice a day).Cardiac surgery was performed 24 h after the diagnosis of infective endocarditis. Cardiac surgeons observed destruction of the mitroaortic intervalvular fibrosa, with dehiscence of the aortic prosthesis, and multiple abscesses. Aortic valve replacement with a biologic prosthesis associated with a reconstruction of the mitroaortic fibrosa was performed. After surgery, linezolid was replaced by daptomycin (8 mg/kg every 48 h) due to acute kidney injury. Serological testing for Bartonella spp. and Coxiella burnetii was negative. Broad-range 16S ribosomal DNA (rDNA) PCR was performed on the cardiac valve, using the primers described by Harris and Hartley (1), followed by sequencing; the results were positive for Mycoplasma hominis. Initially, routine cultures of the cardiac valve performed on standard media, including blood agar and chocolate agar for 48 h and Schaedler broth for 15 days, remained sterile. After the results of the PCR were seen, a culture of the valve was plated on chocolate agar for longer and led to the growth of translucent and tiny colonies after 5 days. A...

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Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

et al. 2015

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“…M. hominis lacks a cell wall, which accounts for negative Gram stain and the ineffectiveness of antibiotics that target peptidoglycan synthesis, such as β-lactams, vancomycin, macrolides, tetracycline, clindamycin and fluoroquinolones (4). The initial treatment for mediastinitis includes aggressive debridement of infected and necrotic sternal tissue, followed by drainage and combination antibiotics (5). The drainage technique may be closed with continuous irrigation, or closed with tube catheters.…”

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confidence: 99%

Vacuum‐assisted closure (VAC)‐Instill^® with continuous irrigation for the treatment of Mycoplasma hominis mediastinitis

Karaca

Kalangos

2014

International Wound Journal

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“…Mycoplasma hominis has previously been reported as the probable cause of a range of extragenital infections. An overview with a focus on sternal infections and mediastinitis is given by Mattila et al (14). Fewer reports exist of human infections with "Flexispira rappini"-like organisms, and there are still unsolved matters concerning their taxonomy.…”

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confidence: 99%

Direct 16S rRNA Gene Sequencing from Clinical Specimens, with Special Focus on Polybacterial Samples and Interpretation of Mixed DNA Chromatograms

et al. 2009

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RipSeq (iSentio, Bergen, Norway) is a web-based application for the analysis of mixed DNA chromatograms.It opens the possibility to analyze chromatograms obtained by direct 16S rRNA gene sequencing from polybacterial human clinical samples. In this study, we used direct 16S rRNA gene sequencing to investigate 264 samples from a wide range of suspected human bacterial infections. The sequence-based identification was compared with the results from routine culture-based identification. A total of 151 samples were positive by the first PCR, producing 85 pure and 66 mixed DNA chromatograms. All mixed chromatograms were analyzed by RipSeq, although seven were so complex that only the dominant bacterial sequences could be identified. In general, sequence-based identification detected a larger number of species than did culture for samples from patients who had received antibiotics prior to sample collection and for samples containing anaerobic bacteria. RipSeq made it possible to apply this supplementary diagnostic tool to typical polybacterial specimens, such as internal abscesses, pleural fluids, and bile.Detection and identification of bacteria directly from clinical samples by broad-range PCR targeting the 16S rRNA gene and DNA sequencing (direct 16S rRNA gene sequencing) make up a well-established method in many laboratories. This method gives the possibility to identify bacteria that died during transportation or as a consequence of antibiotic treatment and to uncover bacteria with special growth requirements. The latest advances in PCR and sequencing technology also offer a more rapid identification than that obtained with standard phenotypic methods that depend on bacterial growth.Because of difficulties in the interpretation of DNA chromatograms resulting from direct sequencing of polybacterial samples, the use of this diagnostic tool has been limited to infections that are predominantly monobacterial. We earlier described RipSeq (iSentio, Bergen, Norway), a web-based application for the analysis of mixed DNA chromatograms (12). In the same article, we presented the RipSeq performance on a number of mixed DNA chromatograms obtained by direct sequencing from saline suspensions containing two and three different bacterial species and discussed the possible benefits and limitations one could experience if the method was to be applied to human clinical samples. In this study, direct 16S rRNA gene sequencing was used to investigate 264 human clinical samples from a wide range of locations, including typical polybacterial specimens such as abscesses and pleural fluids. All mixed DNA chromatograms were analyzed with the RipSeq program, and the sequence-based results were compared to routine culture-based diagnostics in our hospital laboratory.We also discuss special concerns in the selection of a lysis procedure and primers for use on polymicrobial samples as well as the establishment of a reliable negative control.

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Life-Threatening Mycoplasma hominis Mediastinitis

Cited by 44 publications

References 36 publications

Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

Vacuum‐assisted closure (VAC)‐Instill^® with continuous irrigation for the treatment of Mycoplasma hominis mediastinitis

Direct 16S rRNA Gene Sequencing from Clinical Specimens, with Special Focus on Polybacterial Samples and Interpretation of Mixed DNA Chromatograms

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Life-Threatening Mycoplasma hominis Mediastinitis

Cited by 44 publications

References 36 publications

Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

Mycoplasma hominis, a Rare but True Cause of Infective Endocarditis

Vacuum‐assisted closure (VAC)‐Instill® with continuous irrigation for the treatment of Mycoplasma hominis mediastinitis

Direct 16S rRNA Gene Sequencing from Clinical Specimens, with Special Focus on Polybacterial Samples and Interpretation of Mixed DNA Chromatograms

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Vacuum‐assisted closure (VAC)‐Instill^® with continuous irrigation for the treatment of Mycoplasma hominis mediastinitis