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Community‐acquired Chryseobacterium indologenes in an immunocompetent patient

Authors:
Vitoria Cunha at Hospital Garcia de Orta
Vitoria Cunha
Melanie Ferreira at Hospital Garcia de Orta
Melanie Ferreira
Ana Glória Fonseca at Universidade NOVA de Lisboa
Ana Glória Fonseca
José Diogo
José Diogo
José Diogo
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Abstract

Introduction: Chryseobacterium indologenes is a rare pathogen in the human microflora. Nearly half of the published cases refer to nosocomial infections, and the vast majority of patients had underlying immunocompromising conditions. The clinical evolution is usually conducive to antibiotic treatment, but despite being low‐virulent bacteria, infections have often been associated with a high mortality rate as a result of the increased resistance to antibiotics, and the absence of a gold standard for management. Case presentation: A 60‐year‐old male immunocompetent patient was admitted for acute onset of fever, abdominal pain and dysuria. Blood and urine cultures were positive for multiresistant C. indologenes, susceptible only to ciprofloxacin. Clinical improvement was observed on ciprofloxacin antibiotic therapy. Conclusion: This is, to the best of our knowledge, the first Portuguese report of community‐acquired C. indologenes bacteraemia in an immunocompetent patient, a rare disease agent with low pathogenicity but capable of causing severe illness.
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Case Report Community-acquired Chryseobacterium
indologenes in an immunocompetent patient
Vito
´ria Cunha,
1
Melanie Ferreira,
1
Ana Glo
´ria Fonseca
1
and Jose
´Diogo
2
Correspondence
Vito
´ria Cunha
vitoria.mcunha@gmail.com
Received 14 November 2013
Accepted 30 January 2014
1
Department of Medicine, Hospital Garcia de Orta, Av. Torrado da Silva, Almada, Portugal
2
Department of Clinical Microbiology, Hospital Garcia de Orta, Av. Torrado da Silva, Almada,
Portugal
Introduction: Chryseobacterium indologenes is a rare pathogen in the human microflora. Nearly
half of the published cases refer to nosocomial infections, and the vast majority of patients had
underlying immunocompromising conditions. The clinical evolution is usually conducive to
antibiotic treatment, but despite being low-virulent bacteria, infections have often been
associated with a high mortality rate as a result of the increased resistance to antibiotics, and the
absence of a gold standard for management.
Case presentation: A 60-year-old male immunocompetent patient was admitted for acute onset
of fever, abdominal pain and dysuria. Blood and urine cultures were positive for multiresistant C.
indologenes, susceptible only to ciprofloxacin. Clinical improvement was observed on
ciprofloxacin antibiotic therapy.
Conclusion: This is, to the best of our knowledge, the first Portuguese report of community-
acquired C. indologenes bacteraemia in an immunocompetent patient, a rare disease agent with
low pathogenicity but capable of causing severe illness.
Keywords: Chryseobacterium indologenes; ciprofloxacin; immunocompetent; multidrug
resistance; urinary tract infection.
Introduction
Chryseobacterium indologenes is a rare pathogen in the
human microflora, although it is widely distributed in
nature (Chen et al., 2012). Its clinical significance has not
been fully established because this bacteria has not been
recovered frequently from clinical specimens (Bhuyar et
al., 2012). Nearly half of the published cases refer to
nosocomial infections, and the vast majority of patients
had underlying immunocompromising conditions (Kirby
et al., 2004; Reynaud et al., 2007; Lin et al., 2010; Chou
et al., 2011; Bhuyar et al., 2012; Chen et al., 2012; Shah
et al., 2012; Souza de Souza et al., 2012): the present case is
an exception.
The clinical evolution is usually conducive to antibiotic
treatment, but, despite not being virulent bacteria,
infections have often been associated with a high
mortality rate. There is no gold standard or guideline
for the management of C. indologenes infection, despite
increasing evidence of healthcare-associated infections. An
increased resistance rate to previously potent antibiotics
suggests that a resistant pattern of C. indologenes may
evolve over time and may vary according to different
trends of antibiotic usage. The susceptibility study is not
standardized and MIC values have not been established
(Lin et al., 2010).
Case report
A 60-year-old male patient was hospitalized in January
2013 for acute onset of fever, abdominal pain, nausea and
dysuria. He had a non-characterized chronic neurodegen-
erative disease causing symmetrical lower limb weakness
without neurogenic bladder and therefore used a wheel
chair for locomotion. There were no other medical
conditions, i.e. diabetes or immunosuppression, no pre-
vious medication and no allergies. He was a non-smoker
and non-drinker. There was no recent history of hospital
admission, intravenous antibiotic therapy, indwelling
catheters, or invasive procedures or devices.
At admission, he was alert, had stable vital signs (blood
pressure 113/65 mmHg, heart rate 88 bpm, RR 18 cp), and
was febrile (38.1 uC) and dehydrated. Cardiopulmonary
examination was unremarkable; there was lower abdom-
inal tenderness and a negative Murphy sign and no
peripheral oedema. Blood tests revealed leukocytosis
(30610
9
l
21
with 94.5 % neutrophils), elevated C-reactive
protein (39 mg dl
21
), an erythrocyte sedimentation rate of
40 mm in the first hour, and normal liver function tests
and renal function (urea 27 mg dl
21
and creatinine 0.2 mg
dl
21
), hypokalaemia (3 mmol l
21
), with blood ionogram-
being otherwise within the normal range (sodium,
calcium, phosphorus and magnesium).
JMM Case Reports (2014) DOI 10.1099/jmmcr.0.000588
G2014 The Authors. Published by SGM
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/). 1
Because of the urinary tract symptoms despite the
apparently normal urinalysis, the patient was startedem-
pirically on cefuroxime after blood (3 and urine samples
were collected for cultures. After 48 h, C-reactive protein
was down to 7.4 mg dl
21
and there was no leukocytosis or
neutrophilia. On day 4, blood and urine cultures came
back positive for multiresistant C. indologenes, susceptible
only to ciprofloxacin (resistant to piperacilin-tazobactam,
ceftazidime, carbapenems, aztreonam, gentamicin, amika-
cin, tobramycin and colistin). The treatment was adjusted
accordingly. Matrix-assisted laser desorption/ionisation-
time of flight mass spectrometry was used to identify the
bacteria (the reliability of identification was in accordance
with the manufacturer’s instructions, with a score above
2.0), as molecular methods were not available in our
laboratory. The laboratory used the breakpoints for
Pseudomonas aeruginosa accordingly to Clinical and
Laboratory Standards Institute guidelines.
Urological workup identified an enlarged prostate (benign
prostatic hyperplasia). Tests were negative for human
immunodeficiency virus types 1 and 2. The patient
completed a 2-week ciprofloxacin course and evolution
was favourable, with complete remission of the symptoms.
Discussion
C. indologenes is the main species of the genus
Chryseobacterium (Chen et al., 2012). It is a Gram-negative
bacillus (Reynaud et al., 2007; Lin et al., 2010; Chou et al.,
2011; Bhuyar et al., 2012) and a rare pathogen in the
human microflora, although it is widely distributed in
nature (Chen et al., 2012). According to the SENTRY
Antimicrobial Surveillance Program, Chryseobacterium
spp. represent 0.03 % of the total isolates and account
for 0.03 % (50 out of 155?811) of all bacteraemia cases
(Sakurada, 2008). Reported infections also include venti-
lator-associated pneumonia and urinary tract infections,
and they are often associated with a high mortality rate
(Bhuyar et al., 2012; Souza de Souza et al., 2012).
Nearly half of the published cases refer to nosocomial
infections, and the vast majority of patients had underlying
immunocompromising conditions (Bhuyar et al., 2012).
Of all the previous reports, the main differences with the
present case were the immunosuppression state, the
antibiotic susceptibility and the mortality rate (Lin et al.,
2010; Chou et al., 2011; Chen et al., 2012), and, with the
exception of one report in the literature (Reynaud et al.,
2007), the present case is the only incidence of bacteraemia
reported in an immunocompetent patient and that was
only community acquired.
C. indologenes is intrinsically resistant to carbapenems and
cephalosporins due to its production of molecular class
Ab-lactamase and class B carbapenem-hydrolysing b-
lactamase/metallo-b-lactamase. According to SENTRY,
ciprofloxacin showed activity of around 85 % against C.
indologenes(Sakurada, 2008), and in a recent study,
piperacillin-tazobactam was no longer effective (Chen
et al., 2012).
In conclusion, although the clinical significance of C.
indologenes remains uncertain, infections may be commu-
nity acquired and occur in the absence of an underlying
condition. Thus, there is a need for proper identification of
this minor virulent but resistant organism, as prognosis
can be favourable if antibiotic therapy is based on correct
agent identification and susceptibility testing.
References
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V. Cunha and others
2JMM Case Reports
... Only six of our patients were immunocompromised, in contrast to previous reports where a vast majority of the patients were immunocompromised. [26] The present study had three cases where repeat isolation occurred, two of which had recurrent episodes with the same organism 2 and 9 days later, respectively. Among the repeat isolates, 7 and 7a were identical thereby showing its persistence in the urinary tract as a colonizer as the patient did not show any symptoms of UTI. ...
... It was found that all the strains in this study were resistant to ceftazidime, cefepime, levofloxacin, ciprofloxacin and imipenem and a majority (94.7%) of them were resistant to piperacillin-tazobactam using disk diffusion method. Earlier reports have shown ciprofloxacin resistance in 85% of C. indologenes isolates and ineffectiveness of piperacillin-tazobactam. [26] These findings are in contrast to the SENTRY study in 2004 where >85% of the strains were susceptible to piperacillin-tazobactam, cefepime and ceftazidime and similar to findings of the study by Chen et al. who found that only 7.7% strains were sensitive ceftazidime, cefepime, imipenem and meropenem, both of which used the MIC testing for determining the susceptibility. [3,15] However, the high resistance to fluoroquinolones found in the present study is alarming preventing the use of these drugs in our scenario. ...
... [27] C. indologenes is known for its intrinsic resistance to carbapenems and cephalosporins due to the presence of class A and B β-lactamases. [26] Bellais et al. showed heterogeneity in metallo β-lactamases in Chryseobacterium species. [28] We found all except five isolates showing the presence of carbapenemases although in vitro resistance was shown to carbapenems by them which may show other mechanisms such as increased efflux pump expression, decreased porin expression and increased chromosomal cephalosporinases may play a role in carbapenem resistance; although, we did not perform the genotypic screening. ...
Increased Recognition of Chryseobacterium Species as an Emerging Cause of Nosocomial Urinary Tract Infection Following Introduction of Matrix-Assisted Laser Desorption/Ionisation-Time of Flight for Bacterial Identification
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  • Oct 2017
  • Indian J Med Microbiol
Chryseobacterium species are rarely reported as aetiological agents of nosocomial urinary tract infection. Here, we evaluated the clinical significance of 19 isolates of Chryseobacterium species (15 Chryseobacterium indologenes and 4 Chryseobacterium gleum; identified by matrix-assisted laser desorption/ionisation-time of flight [MALDI-TOF]) obtained from urine or percutaneous nephrostomy drainage of 16 patients with urological complaints. The strains possessed drug resistance to multiple antibiotics. 14 isolates showed the presence of carbapenemases. Both MALDI-TOF and repetitive sequence-based-polymerase chain reaction grouped them into three clusters (Kappa 1.000). They may colonise the urinary tract acting as a reservoir for dissemination of drug resistance within hospital environment.
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... However, only few cases were reported in immunocompetent patient. So, in Portugal in 2014, Cunha et al, reported a case of a 60-year-old man, who presented community acquired C. indologenes in immunocompetent patient, susceptible only to ciprofloxacin® [7]. So, C. indologenes was a rare disease agent with low pathogenicity but capable of causing severe illness. ...
... Country Year Age / Gender Predisposition factor Clinical sign Treatment Evolution Acosta et al, [1] Spain 2013 86/F Diabetes Cardiac failure Levofloxacin (Empiric) Uneventful Omar et al, [2] Senegal 2015 42/F Leukemia Acute fever Ceftriaxone (Resistant) Death Palewar et al, [3] India 2017 52/M Diabetes Urinary infection Trimethoprime-Sulfamethoxazole Uneventful Palewar et al, [3] India 2017 38/F Uterine myoma Dysuria Ciprofloxacin or Levofloxacin Uneventful Bhuyar et al, [4] India 2012 19/F Urinary catheter Fever, dysuria Piperacillin-Tazobactame Uneventful Solanke et al, [5] India 2016 21/F Post-abortion Acute fever Tigecycline Uneventful Mukerji et al, [6] USA 2016 63/M Urinary catheter Acute fever, dysuria Piperacillin-Tazobactame Uneventful Cunha et al, [7] Portugal 2014 60/M Immuno-competent Sepsis dysuria Ciprofloxacin or Levofloxacin Uneventful Yadav et al, [11] India 2018 56/M Leukemia Acute fever Nitrofurantoin Uneventful ...
View
... It is important to note that the bacterium resists chlorination and can be found in municipal water supplies. Notably, there can be Chryseobacterium indologenes infections in immunocompetent individuals, including infants, as well [5,6]. ...
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Chryseobacterium indologenes (C. indologenes) is an increasingly common multidrug-resistant organism (MDRO) and is not part of the normal human flora. It is most commonly found in patients who are immunocompromised and/or in poor health, with multiple comorbidities. As an increasingly identified MDRO, C. indologenes needs to be identified early, especially in patients with multiple comorbidities, organ transplants, or on mechanical ventilation. We present a case of a young immunocompromised male with an extensive kidney disease history who acquired this new MDRO bacteria, C. indologenes.
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... Although the clinical significance and pathogenicity of C. indologenes are not well established (17,18), C. indologenes is known to be naturally resistant to a wide variety of antibiotics including not only aminoglycosides, tetracyclines, chloramphenicol, macrolides, aminopenicillins, clindamycin, teicoplanin but also first-generation cephalosporins, aztreonam, ticarcillin-clavulanate, and carbapenems (10,(19)(20)(21). The most potent drugs reported against C. indologenes are quinolones (gatifloxacin and levofloxacin), minocycline, and trimethoprimsulfamethoxazole (18,22,23); however, many studies show an alarming trend in resistance to those antibiotics (3,9,24). ...
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Chryseobacterium indologenes is a non-glucose-fermenting Gram-negative bacillus. This emerging multidrug resistant opportunistic nosocomial pathogen can cause severe infections in neonates and immunocompromised patients. This study aimed to present the first detailed draft genome sequence of a multidrug-resistant C. indologenes strain isolated from the cerebrospinal fluid of an infant hospitalized at the Neonatal Intensive Care Unit of Brazilian Tertiary Hospital. We first analyzed the susceptibility of C. indologenes strain to different antibiotics using the VITEK 2 system. The strain demonstrated an outstanding resistance to all the antibiotic classes tested, including β-lactams, aminoglycosides, glycylcycline, and polymyxin. Next, C. indologenes was whole-genome-sequenced, annotated using Prokka and Rapid Annotation using Subsystems Technology (RAST), and screened for orthologous groups (EggNOG), gene ontology (GO), resistance genes, virulence genes, and mobile genetic elements using different software tools. The draft genome contained one circular chromosome of 4,836,765 bp with 37.32% GC content. The genomic features of the chromosome present numerous genes related to cellular processes that are essential to bacteria. The MDR C. indologenes revealed the presence of genes that corresponded to the resistance phenotypes, including genes to β-lactamases ( bla IND– 13 , bla CIA– 3 , bla TEM– 116 , bla OXA– 209 , bla VEB– 15 ), quinolone ( mcb G), tigecycline ( tet (X6)), and genes encoding efflux pumps which confer resistance to aminoglycosides ( Ran A/ Ran B), and colistin ( Hly D/ Tol C). Amino acid substitutions related to quinolone resistance were observed in GyrA (S83Y) and GyrB (L425I and K473R). A mutation that may play a role in the development of colistin resistance was detected in lpxA (G68D). Chryseobacterium indologenes isolate harbored 19 virulence factors, most of which were involved in infection pathways. We identified 13 Genomic Islands (GIs) and some elements associated with one integrative and conjugative element (ICEs). Other elements linked to mobile genetic elements (MGEs), such as insertion sequence (ISEIsp1), transposon (Tn5393), and integron (In31), were also present in the C. indologenes genome. Although plasmids were not detected, a ColRNAI replicon type and the most resistance genes detected in singletons were identified in unaligned scaffolds. We provided a wide range of information toward the understanding of the genomic diversity of C. indologenes , which can contribute to controlling the evolution and dissemination of this pathogen in healthcare settings.
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... In the literature, most cases of C. indologenes referred to nosocomial infections detected in immunocompromised patients with mechanical ventilation or indwelling catheters or with severe underlying disease, such as malignancies, diabetes mellitus, neutropenia and prolonged treatment with antibiotics 5 . Recently even non-catheter-related community-acquired C. indologenes bacteremia in immunocompetent patients have been reported [6][7][8][9] . The most common clinical manifestations of C. indologenes infections are primary bacteremia, catheter-related bacteremia, wound sepsis, cellulitis, ocular infections, meningitis, pyelonephritis, peritonitis, biliary tract infections and ventilator-associated pneumonia 3,5 . ...
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... Chryseobacterium spp. usually cause infections in patients' with underlying medical illness, newborn or elderly with immunocompromising status, indwelling intravascular catheter, renal calculi long-term broad-spectrum antibiotics etc. 1,2,4,5,8,[10][11][12] Very few case reports of infection by this organism in immunocompetent patients are also available 13,14 . It can cause various infections like bacteriemia, ventilator associated pneumonia (VAP), pyonephritis, biliary tract infection, lumboperitoneal shunt infection, ocular infections, burn wound infections etc. 1,2,[15][16][17][18] Some authors believe that after introduction of colistin and tigecycline, prevalence of C. indologenes infections have been increased 2,5 . ...
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... However, in recent years, the incidence of Chryseobacterium indologenesrelated infections has been increasing, particularly in immunosuppressed patients and in newborns (4). It may be the cause of bacteremia and pneumonia as well as peritonitis, meningitis, endocarditis, pyomyositis, keratitis and urinary system infections (4,7,8). ...
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... Chryseobacterium indologenes is invariably resistant to aminoglycosides, shows varying degree of resistance to carbapenems, cephalosporins, piperacillin-tazobactam and are susceptible to fluroquinolones and cotrimoxazole. Based on the sensitivity pattern reported in SEN-TRY [15] and other literatures [9,10,17], there was no evident difference for community acquired isolates as compared with hospital acquired strains. ...
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Ten patients with intensive care unit (ICU)-acquired Chryseobacterium indologenes bacteremia between January 2004 and December 2008 were studied. The primary site of infection was unknown for 80% of the cases. The known primary sites of infection were empyema (10%) and catheter-related bacteremia (10%). Eight patients (80%) had polymicrobial bacteremia, spent more than 21 days in the ICU, and received more than 14 days of broad-spectrum antibiotic therapy prior to the onset of C. indologenes bacteremia. All isolates were 100% susceptible to minocycline and trimethoprim/sulfamethoxazole. Vancomycin, imipenem, piperacillin/tazobactam, ciprofloxacin, and levofloxacin exhibited 0%, 10%, 20%, 30%, and 30%, respectively, susceptibility against this pathogen. All isolates were 100% resistant to ceftazidime, cefepime, meropenem, piperacillin, and amikacin. The 14-day mortality rate was 40%. Our findings suggest that this pathogen should be included among the causes of ICU-acquired bacteremia, especially in patients with a prolonged stay in an ICU or who had received long-term broad-spectrum antibiotic therapy. Extended-spectrum penicillins, third- and fourth-generation cephalosporins, and quinolones had very little or no effect against this pathogen. Therefore, choosing an appropriate antibiotic therapy for this pathogen is very difficult.
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Antimicrobial Susceptibility and Epidemiology of a Worldwide Collection of Chryseobacterium spp.: Report from the SENTRY Antimicrobial Surveillance Program (1997-2001)
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Limited data are available on Chryseobacterium spp. leading to an evaluation of the patient demographics and susceptibility patterns for Chryseobacterium spp. collected in the first 5 years of the SENTRY Antimicrobial Surveillance Program (1997 to 2001). Fifty isolates (24 Chryseobacterium meningosepticum, 20 Chryseobacterium indologenes, two Chryseobacterium gleum, and 4 Chryseobacterium spp. isolates) were collected. The highest Chryseobacterium prevalence was detected among the elderly. The most active antimicrobials were the newer quinolones (garenoxacin, gatifloxacin, and levofloxacin, each with a MIC at which 90 percent of the isolates are inhibited [MIC90] of 1 μg/ml and 98.0% susceptibility) followed by rifampin (MIC90, 2 μg/ml and 85.7% susceptibility). Trimethoprim-sulfamethoxazole, ciprofloxacin, and piperacillin-tazobactam also showed reasonable activity; vancomycin showed poor potency.
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Clinical and epidemiological features of Chryseobacterium indologenes infections: Analysis of 215 cases
Article
  • Sep 2012
Purpose: This study investigates the clinical and epidemiological features of Chryseobacterium indologenes infections and antimicrobial susceptibilities of C indologenes. Methods: With 215 C indologenes isolates between January 1, 2004 and September 30, 2011, at a medical center, we analyzed the relationship between the prevalence of C indologenes infections and total prescription of colistin and tigecycline, clinical manifestation, antibiotic susceptibility, and outcomes. Results: Colistin and tigecycline were introduced into clinical use at this medical center since August 2006. The increasing numbers of patients with C indologenes pneumonia and bacteremia correlated to increased consumption of colistin (p = 0.018) or tigecycline (p = 0.049). Among patients with bacteremia and pneumonia, the in-hospital mortality rate was 63.6% and 35.2% (p = 0.015), respectively. Administration of appropriate antibiotics showed significant benefit in 14-day survival in patients with C indologenes bloodstream infection (p = 0.040). In bacteremic patients, old cardiovascular accident (p = 0.036) and cancer (p = 0.014) were the most common comorbidity. The most common co-infection pathogen in patients with C indologenes pneumonia was Acinetobacter baumannii (36/91, 39.6%), followed by Pseudomonas aeruginosa (23/91, 25.3%), carbapenem-resistant A baumannii (22/91, 24.2%), and Klebseilla pneumoniae (13/91, 14.3%). Antimicrobial susceptibility testing of the 215 isolates showed that trimethoprim-sulfamethoxazole was the most active agent (susceptibility rate: 87.4%), followed by cefoperazone-sulbactam (48.0%). Conclusion: The present study showed a trend of increasing prevalence of C indologenes infection after introduction of colistin and tigecycline usage. The bacteremia group had higher mortality rate than the pneumonia group. Increasing resistance to piperacillin-tazobactam, ceftazidime, cefepime, and newer fluoroquinolone were noticed in our analysis. Trimethoprim-sulfamethoxazole was a potential antimicrobial agent in vitro for C indologenes. To avoid collateral damage, we emphasize the importance of antibiotic stewardship program.
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Urinary tract infection by Chryseobacterium indologenes
Article
  • Jul 2012
Chryseobacterium species is an uncommon human pathogen although recovered from various sources in the hospital environment. Most infections have been detected in hospitalized patients with severe underlying diseases and who had indwelling devices or implants. Despite their low virulence, chryseobacteria are inherently resistant to many antimicrobial agents. We report a rare case of urinary tract infection by Chryseobacterium indologenes in a young girl, operated for renal calculus and successfully treated with piperacillin-tazobactam combination.
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Chryseobacterium indologenes subcutaneous port-related bacteremia in a liver transplant patient
Article
  • Jan 2012
  • TRANSPL INFECT DIS
Chryseobacterium indologenes is a rare cause of infection in select immunosuppressed hosts. Most prior reports are from Taiwan, in patients with diabetes mellitus or malignancies. Infections caused by C. indologenes are generally associated with indwelling devices, and the organism may be resistant to many commonly utilized broad-spectrum antibiotics. We report the first case, to our knowledge, of C. indologenes subcutaneous port-related bacteremia in a liver transplant recipient. The isolates were resistant to antibiotics previously reported as active, and device removal was required for treatment success.
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Clinical and Microbiological Characteristics of Chryseobacterium indologenes Bacteremia
Article
  • Dec 2010
Reports detailing bacteremia caused by Chryseobacterium indologenes remain limited, with most cases reported in Taiwan. The clinical significance of C. indologenes has not been fully established. This retrospective study investigated the clinical features and antimicrobial susceptibility of C. indologenes bacteremia. Patients with C. indologenes bacteremia were identified at a medical center/teaching hospital in northern Taiwan between January 1, 2004 and January 31, 2008. Clinical features and the antimicrobial susceptibilities of these patients were analyzed. Sixteen isolates of C. indologenes from 16 episodes in 16 patients were identified, with all patients having underlying diseases. Two patients (12.5%) had polymicrobial bacteremia. The portal of bacteremia was not determined in most cases. Other clinical syndromes included catheter-related bacteremia, urinary tract infection and peritonitis. The majority of patients had undergone invasive procedures. Other associated conditions included immunosuppression, neutropenia and prolonged use of antibiotics. Only three patients were treated with appropriate antibiotics according to minimum inhibitory concentrations. The susceptibilities of isolates to trimethoprim-sulfamethoxazole (75.0%), levofloxacin (62.5%), piperacillin-tazobactam (50.0%), ciprofloxacin (43.75%) and cefepime (12.5%) were variable and the bacteremia-related mortality rate was 6.25%. C. indologenes isolates are resistant to multiple antibiotics, with newer fluoroquinolones and trimethoprim-sulfamethoxazole possibly representing the most appropriate antimicrobial agents to treat infections caused by this pathogen. However, the pathogenicity and factors of virulence for C. indologenes remain unclear, with our study revealing favorable outcomes of C. indologenes bacteremia. Epidemiological surveillance of this organism in Taiwan and extensive worldwide surveillance programs are required.
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A severe form of Chryseobacterium indologenes pneumonia in an immunocompetent patient
Article
  • Dec 2007
  • MED MALADIES INFECT
We report a case of severe pneumonia due to Chryseobacterium indologenes in an immunocompetent patient. Chryseobacterium indologenes (formerly Flavobacterium indologenes) are saprophytic Gram-negative rods widely distributed in damp environment. Many sites of infection were described in the literature. These infections are always severe sometimes associated to multiple organ failure. The evolution is usually favorable with antibiotic treatment. Bacteria characteristically grow as yellow-pigmented colonies. They are naturally resistant to many antimicrobial agents. They are usually susceptible to piperacillin(DCI) alone or combined with tazobactam(DCI), ceftazidime(DCI), cefepime(DCI), fluoroquinolones(DCI), rifampin(DCI) and cotrimoxazole(DCI), but the in vitro susceptibility to these antibiotics should be systematically tested. Nevertheless, the optimum antibiotic treatment for Chryseobacterium-related infections remains to be established. In the case we report, the diagnosis was made according to the results of bronchial sample bacterial culture. This case report underlines the need for specific management of patients infected with this species.
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  • Jan 2008
  • Z Sakurada
Sakurada Z, A. (2008). [Chryseobacterium indologenes]. Rev Chilena Infectol 25, 446 (in Spanish).