Oerskovia Species Bacteremia in a Diabetic Patient.

Sir,

Oerskovia species are present mainly in soil and water and are rarely pathogenic for human disease.[123] Oerskovia species represent Gram-positive rod-shaped microorganisms, which were first isolated and described as motile Nocardia.[1] The organism may be distinguished from Nocardia species by the yellow-pigmented colonies without aerial hyphae, motility, and lack of partial acid-fastness.[145] We describe the case of a patient with uncontrolled diabetes mellitus with bacteremia due to Oerskovia species.

A homeless man in his early fifties presented with bilateral lower extremity pain and weakness. Physical examination was significant for multiple plantar and dorsal foot ulcerations with multiple exposed bones and tendons bilaterally. The patient was septic and was started on broad spectrum antibiotic coverage, intravenous vancomycin 1 g every 12 h, cefepime 2 g every 12 h, and metronidazole 500 mg every 8 h for severe skin and soft tissue infection and suspected chronic osteomyelitis. Blood cultures grew Oerskovia species. The most probable source of entry was the open, chronic diabetic foot wounds. In addition, we suspect that patient's severely uncontrolled diabetes mellitus resulted in impaired cellular immunity and susceptibility to invasive infection with this unusual pathogen. Due to patient's nonadherence to intravenous antibiotic administration, the regimen was switched to oral sulfamethoxazole–trimethoprim. Given the severity of infection, the patient underwent a left foot second digit and second metatarsal head resection and right foot transmetatarsal amputation. The patient completed a 21-day course of antibiotic treatment with clearance of bacteremia.

Only a few cases of human infections caused by Oerskovia species have been published to date. Experience with Oerskovia species infections and outcome of treatment is limited. Further studies are required to clarify mechanisms of pathogenicity and clinical manifestations of infections due to Oerskovia species.[45]

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