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Indian Journal of Medical Microbiology, Vol. 29, No. 2, April-June, 2011, pp. 196-198 Correspondence Chryseobacterium indologenes bacteraemia in a preterm baby V Sudharani, Asiya, NK Saxena Department of Microbiology, Gandhi Medical College, Hydearbad, Andhra Pradesh, India Correspondence Address: V Sudharani Department of Microbiology, Gandhi Medical College, Hydearbad, Andhra Pradesh India sudha35947@rediffmail.com Date of Submission: 12-Dec-2010 Code Number: mb11050 PMID: 21654125 DOI: 10.4103/0255-0857.81783 Dear Editor, Chryseobacteria, formerly known as Flavobacterium, was defined in1994 by Vandamme et al.[1] The genus originally comprised six species of yellow-pigmented nonmotile, catalase-positive, oxidase-positive, nonglucose-fermenting Gram negative bacilli that are ubiquitous in nature and are found in plants, soil, food and both fresh and marine water. [2] Six species of Chryseobacterium that are more commonly isolated from clinical specimens are: C. meningosepticum, C. odoratum, C. multivorum, C. breve and group IIb Chryseobacterium spp., which includes C. indologenes and C. gleum.[3] C. meningosepticum is the most pathogenic member of the genus; it is an agent of neonatal meningitis with mortality rates of up to 57%, and is involved to a lesser extent in cases of pneumonia and bacterial sepsis in neonates and adults. [4] In 1993, the first C. indologenes strain was isolated from the tracheal aspirate of a patient with ventilator-associated pneumonia. Protease activity may play an important role in virulence on invasive infections caused by C. indologenes.[5] Risk factors for C. indologenes include underlying medical illness, underlying immunocompromising conditions and presence of indwelling intravascular devices. [6] A specimen of blood was received in our laboratory from NICU for culture and sensitivity. The specimen was from a 36 weeks preterm baby of 1.7 kg birth weight delivered by normal vaginal delivery in a peripheral hospital and was referred to our hospital because of delayed cry and me conium stained liquor. The baby was managed by Ryele′s tube aspiration and was put on a ventilator for about 6 h. Injection cefotaxime 100 mg/kg/day and injection amikacin 15 mg/kg/day were started after sending the blood for culture and sensitivity. Routine laboratory investigations revealed an Hb% of 15 mg/dl, WBC count of 6000/cumm and C-reactive protein of 12 mg/dl. Blood culture was done by the conventional method. On nutrient agar, smooth, circular 1-2-mm yellow pigmented colonies were observed after 24 h [Figure - 1]. On blood agar, 1-2 mm circular, low convex colonies with beta haemolysis were seen. On Mac Conkey agar, there was no growth. Biochemical reactions revealed it to be oxidase-positive, catalase-positive, nonmotile, OF Glucose-A, OF Mannitol negative, Indole-positive, Esculin-positive, Urease-negative, TSI-K/K, nonfermenting Gram negative bacillus. The organism was identified as C. indologenes by conventional biochemical reactions, and the identification was confirmed by an independent laboratory using the Vitek ID-GNB (Vitek 2, version-05.02, Bio Merieux, Inc, Box15969, DURHAM NC,277040969/USA) identification system. The sensitivity of the isolate to the antimicrobial agents was determined by the disk diffusion method. The isolate was sensitive to cefoperazone+sulbactam and piperacillin+tazobactam, and resistant to penicillin, polymyxin and amoxycillin. Environmental samples from NICU were processed but failed to yield C. indologenes. Treatment was started with cefoperazone-sulbactam. The baby improved within 48 h and was shifted to the mother′s room. It is likely that the establishment of an infection by C. indologenes requires the presence of the following factors: the production of a biofilm on foreign materials, a suitable portal of entry and immunodeficiency. [1] In the present case, the baby was preterm and hence immunodeficient and was on ventilator for 6 h; both these factors could have contributed to bacteraemia by C. indologenes. The organism is often resistant to extended-spectrum penicilllins, first-generation and second-generation cephalosporins, ceftriaxone, aztreonem, ticarcillin-clavulanate, chloramphenicol, erythromycin, aminoglycosides, imipenem and meropenem for production of a class B carbapenem-hydrolising enzyme. C. indologenes is usually susceptible to piperacillin alone or combined with tazobactam, ceftazidime, cefipime, fluoroquinolones, rifampin and cotrimoxazole, but the in vitro susceptibility to these antibiotics should be systematically tested. [7] C. indologenes should be considered as a potential pathogen in newborns in the presence of invasive equipment or on treatment with long-term broad-spectrum antibiotics. [7] Appropriate infection control measures such as changing of equipment concerned with humidifying of administering gases every 24 h and thorough hand washing may prevent infection with this opportunistic pathogen. [8] In conclusion, this case shows that C. indologenes should be added to the list of agents that cause severe infections in newborn babies in the presence of invasive equipment or in those with immunodeficiency. References
Copyright 2011 - Indian Journal of Medical Microbiology The following images related to this document are available:Photo images[mb11050f1.jpg] |
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