Piseth Seng1, Boushab Mohamed Boushab2, Fanny Romain3, Frédérique Gouriet4, Nicolas Bruder5, Claude Martin6, Franck Paganelli7, Emmanuelle Bernit8, Yves Patrice Le Treut9, Pascal Thomas10, Laurent Papazian11, Didier Raoult4, Andreas Stein12. 1. Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France. Electronic address: sengpiseth@yahoo.fr. 2. Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France. 3. Service d'Informatique Médicale, Hôpital de la Conception, Marseille, France. 4. Aix-Marseille Université, Faculté de Médecine, Marseille, France. 5. Département d'Anesthésie-réanimation et Soins Intensif, Hôpital de la Timone, Marseille, France. 6. Service d'Anesthésie et de Réanimation, Hôpital Nord, Marseille, France. 7. Département de Cardiologie, Hôpital Nord, Marseille, France. 8. Département de Médecine Interne, Hôpital de la Conception, Marseille, France. 9. Département de Chirurgie Digestive et Transplantation Hépatique, Hôpital de la Conception, Marseille, France. 10. Département de Chirurgie Thoracique, Transplantation Pulmonaire et Maladies Respiratoires, Hôpital Nord, Marseille, France. 11. Réanimation Médicale Détresses Respiratoires - Infections Sévères, Hôpital Nord, Marseille, France. 12. Centre de Référence des Infections Ostéo-Articulaires (CRIOAC) Interrégional Sud Méditerranée, Service des Maladies Infectieuses, Hôpital de la Conception, 147 boulevard Baille, 13005 Marseille, France; Aix-Marseille Université, Faculté de Médecine, Marseille, France.
Abstract
BACKGROUND: Raoultella ornithinolytica is known to inhabit aquatic environments. The clinical features and outcomes of human infections caused by R. ornithinolytica have been reported for only a limited number of cases. METHODS: A retrospective study of cases of infection caused by R. ornithinolytica managed at four university hospital centres during the period before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed. The aim was to describe the clinical and microbiological characteristics, treatments, and outcomes. RESULTS: Among 187 R. ornithinolytica isolates identified for which clinical information was available, 71 were considered colonizers and 116 were pathogenic. A total of 112 cases of R. ornithinolytica infection were identified. Urinary tract infections, gastrointestinal infections, wound and skin infections, and bacteraemia were observed in 36%, 14%, 13%, and 5% of cases, respectively. Associated infections that have been poorly reported, such as respiratory infections, i.e. pneumonia and pleural effusion, were observed in 24% of cases. Additional diseases reported here for the first time included osteomyelitis, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis, and otitis. The proportion of R. ornithinolytica isolates resistant to antibiotics was found to be relatively high: 4% of isolates were resistant to ceftriaxone, 6% to quinolones, and 13% to co-trimoxazole. The mortality rate related to infection was 5%. CONCLUSIONS: R. ornithinolytica is an underreported, emerging hospital-acquired infection and is particularly associated with invasive procedures. R. ornithinolytica should never be considered simply a saprophytic bacterium that occasionally contaminates bronchial lavage or other deep respiratory samples or surgical sites. Physicians should be aware of the high rates of antimicrobial resistance of R. ornithinolytica isolates so that immediate broad-spectrum antibiotic treatment can be established before accurate microbiological results are obtained.
BACKGROUND:Raoultella ornithinolytica is known to inhabit aquatic environments. The clinical features and outcomes of humaninfections caused by R. ornithinolytica have been reported for only a limited number of cases. METHODS: A retrospective study of cases of infection caused by R. ornithinolytica managed at four university hospital centres during the period before and after the introduction of matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) was performed. The aim was to describe the clinical and microbiological characteristics, treatments, and outcomes. RESULTS: Among 187 R. ornithinolytica isolates identified for which clinical information was available, 71 were considered colonizers and 116 were pathogenic. A total of 112 cases of R. ornithinolytica infection were identified. Urinary tract infections, gastrointestinal infections, wound and skin infections, and bacteraemia were observed in 36%, 14%, 13%, and 5% of cases, respectively. Associated infections that have been poorly reported, such as respiratory infections, i.e. pneumonia and pleural effusion, were observed in 24% of cases. Additional diseases reported here for the first time included osteomyelitis, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis, and otitis. The proportion of R. ornithinolytica isolates resistant to antibiotics was found to be relatively high: 4% of isolates were resistant to ceftriaxone, 6% to quinolones, and 13% to co-trimoxazole. The mortality rate related to infection was 5%. CONCLUSIONS:R. ornithinolytica is an underreported, emerging hospital-acquired infection and is particularly associated with invasive procedures. R. ornithinolytica should never be considered simply a saprophytic bacterium that occasionally contaminates bronchial lavage or other deep respiratory samples or surgical sites. Physicians should be aware of the high rates of antimicrobial resistance of R. ornithinolytica isolates so that immediate broad-spectrum antibiotic treatment can be established before accurate microbiological results are obtained.
Authors: Alina Iovleva; Roberta T Mettus; Christi L McElheny; Marissa P Griffith; Mustapha M Mustapha; A William Pasculle; Ryan K Shields; Vaughn S Cooper; Yohei Doi Journal: Antimicrob Agents Chemother Date: 2019-12-20 Impact factor: 5.191