Journal List > Kosin Med J > v.33(3) > 1119977

Oh, Jung, Ko, Lee, Park, and Lee: Bacteremia caused by Leuconostoc species : 6-case series

Abstract

Leuconostoc species are Gram-positive coccobacilli and are used in dairy products and are intrinsically resistant to vancomycin. Leuconostoc infections are rare in humans, usually occurring in immune-compromised patients. We describe 6 patients with Leuconostoc bacteremia at Dong-A university hospital between 1990 and 2015. One isolate (L. lactis) was identified to species level using 16S rRNA gene sequencing analysis. All patients had underlying diseases and 5 patients underwent procedures that interrupted the normal integumentary defense. Four patients died within 30 days after being identified as carrying Leuconostoc species.

REFERENCES

1.Templin KS., Crook T., Riley T 3rd., Whitener C., Aber RC. Spontaneous bacterial peritonitis and bacteremia due to Leuconostoc species in a patient with end-stage liver disease; a case report. J Infect. 2001. 43:155–7.
crossref
2.Handwerger S., Horowitz H., Coburn K., Kolokathis A., Wormser G. Infection due to Leuconostoc species: six cases and review. Rev Infect Dis. 1990. 12:602–10.
crossref
3.Kim GY., Kim MH., Park SY., Park MJ., Suh JT., Lee HJ. A case of bacteremia caused by Leuconostoc lactis identified by 16S rRNA sequencing. Korean J Clin Microbiol. 2006. 9:137–41.
4.Shin J., Her M., Moon C., Kim D., Lee S., Jung S. Leuconostoc bacteremia in a patient with amyloidosis secondary to rheumatoid arthritis and tuberculosis arthritis. Mod Rheumatol. 2011. 21:691–5.
5.Shin KS., Han KD., Hong SB. Septicemia caused by Leuconostoc lactis with intrinsic toleranceto vancomycin in a patient with biliary stent. Korean Journal of Biomedical Laboratory Sciences. 2013. 19:280–3.
6.Lee MR., Huang YT., Lee PI., Liao CH., Lai CC., Lee LN, et al. Healthcare-associated bacteremia caused by Leuconostoc species at a university hospital in Taiwan between 1995 and 2008. J Hosp Infect. 2011. 78:45–9.
7.Moise-Broder PA., Sakoulas G., Eliopoulos GM., Schentag JJ., Forrest A., Moellering RC Jr. Accessory gene regulator group II polymorphism in methicillin-resistant Staphylococcus aureus is predictive of failure of vancomycin therapy. Clin Infect Dis. 2004. 38:1700–5.
crossref
8.Coovadia YM., Solwa Z., van Den Ende J. Potential pathogenicity of Leuconostoc. Lancet. 1988. 1:306.
crossref
9.Swenson JM., Facklam RR., Thornsberry C. Antimicrobial susceptibility of vancomycin- resistant Leuconostoc, Pediococcus, and Lactobacillus species. Antimicrob Agents Chemother. 1990. 34:543–9.
10.Jordan JA., Durso MB. Comparison of 16S rRNA gene PCR and BACTEC 9240 for detection of neonatal bacteremia. J Clin Microbiol. 2000. 38:2574–8.
crossref
11.Sleigh J., Cursons R., Pine ML. Detection of bacteraemia in critically ill patients using 16S rDNA polymerase chain reaction and DNA sequencing. Intensive Care Med. 2001. 27:1269–73.
crossref

Fig. 1.
The phylogenetic relationships of isolate DAU-03 with other related Leuconostoc strains based on 16S rRNA gene sequences
kmj-33-422f1.tif
Table 1.
Clinical feature of 6 patients with L. species bacteremia
Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6
Organism L. lactis L. pseudomes-enteroides L. pseudomes-enteroides L. mesenteroides L. citreum L. citreum
Age/ Sex 75/M 56/M 80F 65M 73F 60M
Underlying disease
Malignancies Pancreas cancer External auricular cancer Early gastric cancer Cholangio-carcinoma, Adavanced gastric cancer
Diabetes + + + - - -
Others Indwelling venous catheter C Cholecystitis Central catheter Chronic hepatitis BVenous port Congestive heart failure Atrial fibrillation Venous port Congestive heart failure Central catheter Venous port
*WBC(/mm3) 10,290 11,600 11,780 4,250 10,690 16,380
*CRP(mg/dL) 31.06 17.16 7.21 5.12 9.86 20.66
Antibiotics Imipenem Ticarcillin /clavulanate Levofloxacin Cefepime Ceftriaxone Teicoplanin, Meropenem
All-cause mortality Died Died Survived Survived Died Died

* Reference range: WBC 3,000–10,000(/mm3), CRP 0–0.5(mg/dL)

Adminitrated after Leuconostoc species identification

All cause mortality in 30 days

Table 2.
Antimicrobial susceptibility of isolates of L. isolates
Patient 1 L. lactis Patient 2 L. pseudomes-enteroides Patient 3 L. pseudomes-enteroides Patient 4 L. mesenteroides Patient 5 L. citreum Patient 6 L. citreum
Ampicillin I (4)* S (< = 0.25) I (0.5) I (2) S (< = 2) I (4)
Imipenem S (< = 1)
Ciprofloxacin S (1)
Penicillin G I (0.5) I (0.25) I (0.25) I (1) S (1) I (2)
Vancomycin R (> = 8) R (> = 8) R (> = 8) R (>=8) R (> = 32) R (> = 8)
Clindamycin I (0.5) S (< = 0.25) S (< = 0.25) S (<=0.25) S (< = 0.25) S (< = 0.25)
Erythromycin S (< = 0.12) S (< = 0.12) S (< = 0.12) S (<=0.12) S (< = 0.25) S (< = 0.12)
Tetracyclin S (2) S (2) S (2) S (2) S (4) S (0.5)
Levofloxacin S (1) I (4) S (1) I (4) I (4) S (2)
Teicoplanin R (> = 32)
Norfloxacin R (> = 16)
Gentamicin S (SYN-S)
Cefazolin S (2)
Ceftriaxone R (> = 8) R (> = 8) R (> = 8) R (> = 8) R (> = 8)
Cefotaxime R (4) R (4) R (> = 8) R (> = 8) R (> = 8)
Linezolid S (< = 2) S (< = 2) S (< = 2) S (< = 2) S (< = 2)

* Minimal inhibitory concentration (MIC)

SYN: Synergistic

TOOLS
Similar articles