Bacteremia caused by Leuconostoc species : 6-case series

Ki Jong Oh; Dong Sik Jung; Kwan Soo Ko; Ho Jin Lee; Jun Yong Park; Hyuck Lee

doi:10.7180/kmj.2018.33.3.422

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Case Reports Bacteremia caused by Leuconostoc species : 6-case series: Ki Jong Oh¹, Dong Sik Jung¹, Kwan Soo Ko², Ho Jin Lee¹, Jun Yong Park¹, Hyuck Lee¹; Kosin Medical Journal 2018;33(3):422-430.
DOI: https://doi.org/10.7180/kmj.2018.33.3.422
Published online: January 19, 2018

¹Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea

²Department of Molecular Cell Biology, Sungkyunkwan University College of Medicine, Suwon, Korea

Corresponding Author: Dong Sik Jung, Department of Internal Medicine, Dong-A University Hospital, 26, Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: +82-51-240-2622 Fax: +82-51-4240-2622 E-mail: dongsik72@hanmail.net

• Received: July 29, 2016 • Accepted: October 19, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Abstract
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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.
Keywords: Bacteremia; Leuconostoc; Vancomycin resistance

Fig. 1.

The phylogenetic relationships of isolate DAU-03 with other related Leuconostoc strains based on 16S rRNA gene sequences

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

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Bacteremia caused by Leuconostoc species : 6-case series

Kosin Med J. 2018;33(3):422-430. Published online January 19, 2018

DOI: https://doi.org/10.7180/kmj.2018.33.3.422

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