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 ~  Abstract
 ~ Introduction
 ~ Case Report
 ~ Discussion
 ~  References

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  Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 31  |  Issue : 3  |  Page : 306-308
 

Ochrobactrum anthropi : An unusual pathogen: Are we missing them?


Department of Microbiology, B. J. Medical College, Pune, Maharashtra, India

Date of Submission16-Mar-2013
Date of Acceptance04-Jun-2013
Date of Web Publication25-Jul-2013

Correspondence Address:
S S Mudshingkar
Department of Microbiology, B. J. Medical College, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0255-0857.115664

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 ~ Abstract 

With increasing incidence of immunocompromised patients, many unusual organisms are emerging as pathogens in these patients. Ochrobactrum anthropi is an emerging opportunistic pathogen in immunocompromised patients. Here, we report two cases of neonates who presented with septicemia due to O. anthropi. Both were preterm and low birth weight babies admitted in the Neonatal Intensive Care Unit of our Hospital. One baby manifested with respiratory distress and eventually died. The second baby responded well to treatment and was discharged. The clinical presentation of infections along with microbiological characteristics and clinical significance of the organism are described.


Keywords: Ochrobactrum anthropi, opportunistic pathogen, septicemia


How to cite this article:
Mudshingkar S S, Choure A C, Palewar M S, Dohe V B, Kagal A S. Ochrobactrum anthropi : An unusual pathogen: Are we missing them?. Indian J Med Microbiol 2013;31:306-8

How to cite this URL:
Mudshingkar S S, Choure A C, Palewar M S, Dohe V B, Kagal A S. Ochrobactrum anthropi : An unusual pathogen: Are we missing them?. Indian J Med Microbiol [serial online] 2013 [cited 2019 Sep 16];31:306-8. Available from: http://www.ijmm.org/text.asp?2013/31/3/306/115664



 ~ Introduction Top


Ochrobactrum anthropi and Ochrobactrum intermedium, formerly designated as centres for disease control (CDC) groups Vd-1 and Vd-2, are emerging pathogens in immunocompromised patients. [1] In the past, O. anthropi and O. intermedium have been regarded as opportunistic human pathogens of low virulence, infecting only immunocompromised patients with underlying diseases. [2] Recent reports on Ochrobactrum infections; however have demonstrated the occurrence of severe O. anthropi infections in immunocompetent hosts without underlying diseases and are associated with implantation of foreign bodies particularly indwelling central venous catheters. [3]


 ~ Case Report Top


We report here two cases of neonatal septicaemia due to O. anthropi, the first of its kind from Western India. The two cases were found within a span of 24 h. The blood culture from 2 nd neonate was positive within 24 h of 1 st culture positive case.

The 1 st neonate was a premature male child with birth weight of 1733 g. The mother had pregnancy induced hypertension and preeclampsia. He was delivered by caesarean section and did not cry at birth. His Apgar score was two at 1 min and five at 5 min after birth, indicating poor prognosis. Despite oronasal suctioning of baby and tactile stimulus, the baby did not cry. His heart rate (HR) was 60/min. The child was intubated with an endotracheal tube no. 3 and intermittent positive pressure ventilation, which lead to an improved HR of 120/min; however, there was no spontaneous effort for respiration. The child was shifted to Neonatal Intensive Care Unit (NICU). The Baby was kept on a ventilator for 3 days. He received intravenous (I.V.) dextrose fluid and fresh frozen plasma. The child was started on I.V. cefotaxime gentamycin and aminophyline drip. After 2 days, he was taken-off the ventilator and was breathing spontaneously. On the 3 rd day, he gradually deteriorated and exhibited signs and symptoms of sepsis such as fever, sclerema and increased leucocyte count (total lymphocyte counts - 21,000/mm 3 ). Two blood culture samples were sent in BACTEC blood culture bottles to Microbiology Department, which grew a non-fermenter gram-negative bacterium. The child developed respiratory distress and was put on ventilator again; he developed pulmonary and intestinal bleeding. On X-ray, right upper lobe consolidation with partial collapse of alveoli was seen. The baby succumbed on the 6 th day. The second neonate was also a male premature baby with a birth weight of 1749 g. He was admitted to the NICU because of prematurity and low birth weight and was started on parenteral dextrose. This baby also developed symptoms of pneumonia and was started on I.V. gentamicin and piperacillin + tazobactum. The leucocyte counts were high (16,000/mm 3 ). Two BACTEC blood culture sample were sent to microbiology, which showed growth of a non-fermenter, which was sensitive to meropenem. The baby was treated with I.V. meropenem for 5 days. He started improving and was discharged on 11 th day.

There were no other culture positive cases due to O. anthropi in Microbiology laboratory during the same duration.

Microbiological processing

The BACTEC blood culture bottles flashed positive within 24 h of incubation in BACTEC (B.D.) machine. The gram stain of broth from both the bottles showed gram-negative rods. Subcultures from the bottles on blood agar and MacConkey's medium showed non-lactose fermenting colonies and both isolates were actively motile rods. The colonies were processed for identification and sensitivity by standard microbiological techniques. In the biochemical reactions, both isolates showed the non-fermenter pattern in triple sugar iron agar and routine sugars such as glucose, lactose, sucrose and mannitol and oxidation of glucose was seen in Hugh Leifson's oxidation-fermentation (glucose) medium. Indole was not produced, methyl red reaction was negative, citrate was not utilised and the organism did not grow in the presence of cetrimide. As the isolates showed non-fermenter like reactions, but it was motile and strong urease positive and weak oxidase positive that could not grow on cetrimide agar, which arose a suspicion in mind ….which is this non-fermenter? The isolates were processed on phoenix B.D. automated system for identification and sensitivity. O. anthropi was identified (confidence level 99%) showing susceptibility to amikacin minimum inhibitory concentration (MIC ≤8), imipenem (MIC ≤1), meropenem (MIC ≤1) and resistance to 3 rd and 4 th generation cephalosporins (ceftazidime and cefepime: MIC ≥16, cefepime MIC ≥32) and gentamicin (MIC ≥8). Corresponding results were obtained on disk diffusion test by Kirby Bauer method.


 ~ Discussion Top


O. anthropi was formerly known as CDC group Vd or Achromobacter. It is a non-fastidious, gram-negative, motile, non-fermenting bacillus with strict oxidative metabolism and possesses a very active urease. O. anthropi shares the same microbial niche as Pseudomonas species such as soil, plants, water sources including normal saline and antiseptic solutions, dialysis fluids, etc. [4],[5] Like Pseudomonas species, O. anthropi is characterized by a broad spectrum of antimicrobial resistance. However, O. anthropi is having low pathogenic potential and thus has rarely been reported as a human pathogen. Most of the published cases are nosocomially acquired infections in debilitated hosts with indwelling medical devices such as central venous catheters, drainage tubes and intraperitoneal catheters on account of its ability to [6],[7] adhere to various synthetic materials. [1],[6],[7] Impaired host immunity, previous antibiotic therapy are also additional risk factors for acquiring infections due to this organism. [8] Braun et al., and Peltroche et al., had reported O. anthropi as the etiological agent causing pyogenic infections complicating indwelling medical devices or surgical procedures, like intraocular lenses. [9]

There are few case reports, which mention about O. anthropi infections in immunocompetent hosts. Kettaneh et al., reported a case of fatal septic shock caused by O. anthopi in an immunocompetent adult. [3] Vaidya et al., has recently published a review of the literature on O. anthropi infections in patients with the normal immune status. [10]

In case reports, both neonates were premature with compromised immune status, admitted in a high risk area of hospital like NICU, both were on a broad spectrum antibiotics and were on invasive long standing I.V. lines. The 1 st neonate was on mechanical ventilation and the blood culture received by us was 48 h after admission. Hence, it is possible to conclude that both babies developed nosocomially acquired bacteremia, the pathogen being an unusal one like…. O. anthropi. Though we could not find any common source for infection in both neonates, contaminated I.V. lines or I.V. solutions could have been the source of infection in both babies. In the previous case reports also contaminated I.V. lines and I.V. fluids had acted as the source for nosocomial transmission of this organism. [6],[7]

As already stated O. anthropi shares the same environmental niche as that of Pseudomonas and also their close biochemical resemblance (both oxidase positive and actively motile) for clinical microbiologists it's very likely that it can be mistaken for Pseudomonas. But, one needs to remember that the latter is urease positive and does not grow on cetrimide agar.

So while dealing with immunocompromised debilitated hosts, we should not miss out the unusual pathogens like Ochrobactrum, which are generally nosocomially acquired pathogen, affecting immunocompromised individuals. Although this organism seems to be of relatively low virulence, it can produce clinically significant fatal infections in debilitated patients. So, it is very important to follow infection control guidelines to control such opportunistic pathogens in the hospital environment.

 
 ~ References Top

1.Alnor D, Frimodt-Møller N, Espersen F, Frederiksen W. Infections with the unusual human pathogens Agrobacterium species and Ochrobactrum anthropi. Clin Infect Dis 1994;18:914-20.  Back to cited text no. 1
    
2.Kämpfer P, Citron DM, Goldstein EJ, Scholz HC. Difficulty in the identification and differentiation of clinically relevant Ochrobactrum species. J Med Microbiol 2007;56:1571-3.  Back to cited text no. 2
    
3.Kettaneh A, Weill FX, Poilane I, Fain O, Thomas M, Herrmann JL, et al. Septic shock caused by Ochrobactrum anthropi in an otherwise healthy host. J Clin Microbiol 2003;41:1339-41.  Back to cited text no. 3
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4.Delière E, Vu-Thien H, Lévy V, Barquins S, Schlegel L, Bouvet A. Epidemiological investigation of Ochrobactrum anthropi strains isolated from a haematology unit. J Hosp Infect 2000;44:173-8.  Back to cited text no. 4
    
5.Arora U, Kaur S, Devi P. Ochrobactrum anthropi septicaemia. Indian J Med Microbiol 2008;26:81-3.  Back to cited text no. 5
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6.Ezzedine H, Mourad M, Van Ossel C, Logghe C, Squifflet JP, Renault F, et al. An outbreak of Ochrobactrum anthropi bacteraemia in five organ transplant patients. J Hosp Infect 1994;27:35-42.  Back to cited text no. 6
[PUBMED]    
7.Gransden WR, Eykyn SJ. Seven cases of bacteremia due to Ochrobactrum anthropi. Clin Infect Dis 1992;15:1068-9.  Back to cited text no. 7
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8.Braun M, Jonas JB, Schönherr U, Naumann GO. Ochrobactrum anthropi endophthalmitis after uncomplicated cataract surgery. Am J Ophthalmol 1996;122:272-3.  Back to cited text no. 8
    
9.Peltroche-Llacsahuanga H, Brandenburg V, Riehl J, Haase G. Ochrobactrum anthropi peritonitis in a CAPD patient. J Infect 2000;40:299-301.  Back to cited text no. 9
[PUBMED]    
10.Vaidya SA, Citron DM, Fine MB, Murakami G, Goldstein EJ. Pelvic abscess due to Ochrobactrum intermedium corrected in an immunocompetent host: Case report and review of the literature. J Clin Microbiol 2006;44:1184-6.  Back to cited text no. 10
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