Journal List > Korean J Lab Med > v.27(3) > 1011396

Ko, Chung, Sung, and Kim: Emergence of β-Lactam-Dependent Bacillus cereus associated with Prolonged Treatment with Cefepime in a Neutropenic Patient

Abstract

Antibiotic dependence in clinical isolates has been reported, albeit rarely, such as vancomycin-dependent enterococcus and β-lactam-dependent Staphylococcus saprophyticus. We report herein a clinical isolate of β-lactam-dependent Bacillus cereus. A 16-yr-old female was admitted on 8 September 2005 with neutropenic fever during chemotherapy following surgical removal of peripheral neuroectodermal tumor. She had had an indwelling chemoport since August 2004 and experienced B. cereus bacteremia three times during the recent 3-month period prior to the admission; the bacteremias were treated with cefepime-based chemotherapy. On hospital days 1 and 3, B. cereus was isolated from blood drawn through the chemoport. The isolates were resistant to penicillin, ceftriaxone, and erythromycin, and susceptible to vancomycin and ciprofloxacin. The isolate of hospital day 3 grew only nearby the β-lactam disks including penicillin and ceftriaxone on disk diffusion testing. The β-lactam-dependent isolate required a minimum of 0.064 μg/mL of penicillin or 0.023 μg/mL of cefotaxime for growth, which was demonstrated by E test (AB Biodisk, Sweden). Light microscopy and transmission electron microscopy revealed a marked elongation of the dependent strain compared with the non-dependent strain. Prolonged therapy with β-lactams in the patient with an indwelling intravenous catheter seemed to be a risk factor for the emergence of β-lactam-dependence in B. cereus.

References

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Fig. 1.
Summary of blood culture results and antimicrobial treatment. Bacillus cereus were isolated from chemoport blood culture but not from peripheral blood culture on June 30, 2005, July 21, 2005, July 31, 2005, September 8, 2005 (hospital day 1), and September 10, 2005 (hospital day 3). β-lactam-dependent B. cereus was isolated on chemoport blood culture on Sep 10, 2005.
kjlm-27-216f1.tif
Fig. 2.
Antimicrobial susceptibility tests with penicillin (P), ceftriaxone (CRO), erythromycin (E), vancomycin (VA), and ciprofloxacin (CIP) disks for β-lactam-independent Bacillus cereus isolated on hospital day 1 (A) and β-lactam-dependent B. cereus isolated on hospital day 3 (B). β-lactam-dependent isolates showed growth only around the penicillin or ceftriaxone disk. The results of E test with penicillin (C) and cefotaxime (D) showed the degree of β-lactam-dependence. The β-lactam-dependent isolate required a minimum of 0.064 μg/mL of penicillin (PG) or 0.023 μg/mL of cefotaxime (CT) for growth.
kjlm-27-216f2.tif
Fig. 3.
Light microscopy (Gram stain, × 1,000) and electron microscopy (TEM, × 8,000) of β-lactam-independent (A) and β-lactam-dependent B. cereus(B). Predominance of markedly elongated rods in the β-lactam-dependent strain is noted.
kjlm-27-216f3.tif
Fig. 4.
PFGE analysis of B. cereus isolated at July 31, 2005 (lane 1), hospital day 1 (lane 2), hospital day 3 (lane 3), respectively, after restriction with SmaI. B. cereus isolated at July 31, 2005 was closely related to the subsequent two isolates recovered at hospital day 1, which was β-lactam-independent, and hospital day 3, which was β-lactam-dependent, with only one restriction band difference. Isolates on hospital day 1 and hospital day 3 were identical with each other. Lane M, a concatamer of phage λ DNA as a size standard (New England BioLabs Inc., Ipswich, MA, USA).
Abbreviations: ppl, peripheral; N.G., no growth.
kjlm-27-216f4.tif
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