A Case of Catheter-Related Bloodstream Infection by Tsukamurella inchonensis in a Pediatric Patient Receiving Home Intravenous Antibiotic Treatment

Youkyung Seo; Hae-Sun Chung; Yangsoon Lee; Juwon Kim; Dongeun Yong; Seok Hoon Jeong; Seok Joo Han; Kyungwon Lee

doi:10.3343/lmo.2012.2.2.105

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Seo, Chung, Lee, Kim, Yong, Jeong, Han, and Lee: A Case of Catheter-Related Bloodstream Infection by Tsukamurella inchonensis in a Pediatric Patient Receiving Home Intravenous Antibiotic Treatment

Case Report

Clinical Microbiology

Laboratory Medicine Online

Laboratory Medicine Online 2012; 2(2): 105-110.

Published online: 30 March 2012

DOI: https://doi.org/10.3343/lmo.2012.2.2.105

A Case of Catheter-Related Bloodstream Infection by Tsukamurella inchonensis in a Pediatric Patient Receiving Home Intravenous Antibiotic Treatment

Youkyung Seo, M.D.¹, Hae-Sun Chung, M.D.¹, Yangsoon Lee, M.D.¹, Juwon Kim, M.D.¹, Dongeun Yong, M.D.¹, Seok Hoon Jeong, M.D.¹, Seok Joo Han, M.D.², Kyungwon Lee, M.D.¹

¹Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea.

²Department of General Surgery, Yonsei University College of Medicine, Seoul, Korea.

Corresponding author: Dongeun Yong, M.D. Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemu-gu, Seoul 120-752, Korea. Tel: +82-2-2228-2446, Fax: +82-2-313-0908, deyong@yuhs.ac

Received 2 August 2011 Revised 11 October 2011 Accepted 15 November 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Bacteria belonging to the genus Tsukamurella are aerobic, gram-positive rods that are weakly acid-fast with no apparent branching. Infections of the Tsukamurella spp. are generally caused by the use of infected medical devices such as central venous catheters. The underreporting of these infections might be attributable to the frequent misdiagnosis of Tsukamurella infections as Corynebacterium or atypical Mycobacterium spp. infections. Therefore, when gram-positive aerobic rods are observed in the blood culture of a patient with a central venous catheter, it is important to consider Tsukamurella as one of the causative organisms. Here, we report the first case of a catheter-related blood stream infection caused by Tsukamurella inchonensis in a 3-yr-old Korean girl with underlying biliary atresia who underwent hepatoportoenterostomy.

Keywords: Catheter, Blood stream infection, Tsukamurella inchonensis, 16S ribosomal RNA

Figures and Tables

Fig. 1

Macroscopic and microscopic features of the isolated strain. (A) Growth of the strain after 72 hr on blood agar plates; (B) A colony of the strain after 72-hr growth (×10); (C) Gram stain of the strain after a 48-hr growth (×1,000); (D) Modified acid-fast bacilli (AFB) stain of the strain after a 48-hr growth (&1,000)

Fig. 2

A dendrogram illustrating the phylogenetic relationships between our clinical isolate (YMC11-5-B1957) and T. inchonensis, T. paurometabola, T. tyrosinosolvens, T. strandjordae, T. pulmonis, T. carboxydivorans, T. pseudospumae, T. spumae, T. sunchonensis, and T. spongiae strains based on the 16S rRNA gene sequencing. The scale indicates the similarity index.

Table 1

Comparison of the phenotypic characteristics of the clinical isolate with the characteristics of other clinically important Tsukamurella spp.

Abbreviations: -, negative; +, positive; ND, not available; V, variable.

Table 2

Antimicrobial susceptibility of a T. inchonensis isolate from a patient who was treated with antibiotics via an intravenous catheter

Abbreviations: ND, not determined; I, intermediate; R, resistant; S, susceptible; MIC, minimum inhibitory concentration.

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