Title : Catheter-related atlantibacter hermannii sepsis in a hemodialysis patient
Abstract:
Background: Atlantibacter hermannii, previously known as Escherichia hermannii is a rare causative agent of human infections. Several reports testify that the most frequently infected patients are immunosuppressed, especially those undergoing hemodialysis.
Materials and Methods: A 34-year-old man with an end-stage renal disease complained of chills, fever and general fatigue at the end of a regular hemodialysis session. The blood cultures were performed using BD BACTECTM Plus Aerobic/F and BD BACTECTM Plus Anaerobic/F bottles incubated in BACTEC 9120 Blood Culture System. Semiquantitative (roll-plate) culture of a segment from the replaced catheter tip was performed. The bacterial isolate was identified using Vitek 2 Compact. Verification of the automated identification was performed using 16S sequencing. The antimicrobial susceptibility test was performed by using ATS-N222 card on a Vitek 2 compact and minimum inhibitory concentrations were reported by the system automatically.
Results: Physical examination demonstrated that the patient was febrile (39.2?) with a normal pulse rate (80/min) and arterial pressure (140/80 mm/Hg). The laboratory tests were as follow: white blood cells 7.2 x 109/l with 89% neutrophils, C-reactive protein 145 mg/l, hemoglobin 89.0 g/l, erythrocytes 2.7 x 1012/l, hematocrit 0.28 l/l platelets 184 x 109/l and creatinine clearance < 5 mL/min. The echocardiographic examination showed a vegetation located on the dialysis catheter in the right atrium. Empirical therapy was initiated with intravenous gentamicin and after the isolation of the agent, the treatment was continued with intravenous imipenem/cilastatin. The blood cultures and the tip of the replaced catheter were positive for A. hermannii. The 16S sequence product was used to query the NCBI bacterial database and revealed 99.75% identity to that of A. hermannii strain CIP 103176 16S ribosomal RNA in the NCBI GenBank database. The antimicrobial susceptibility results revealed resistance to aminopenicillins and susceptibility to all other tested antimicrobials.
Conclusions: To our knowledge, this is the first report of catheter-related vegetation with echocardiographic confirmation and the successful eradication of A. hermannii infection in a patient undergoing hemodialysis with imipenem/cilastatin.
