Gordonia sputi-associated bloodstream infection in a renal transplant patient with chronic indwelling central venous catheter: a case report and literature review
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Introduction. Although rare, human infections caused by Gordonia spp. have been reported, especially within the immunocompromised population and those with long-term indwelling devices. We report a case of Gordonia spp. bacteraemia in a renal transplant patient and present a literature review on microbiological identification methods of this organism.
Case Presentation. A 62-year-old female renal transplant recipient admitted to hospital with a 2-month history of dry cough and fevers occurring weekly when receiving electrolyte replacement infusions via a Groshong line. Over 2 weeks, blood cultures repeatedly isolated a Gram-positive bacillus solely in aerobic bottles, and this was initially reported as Rhodococcus spp. by the local microbiology laboratory. Chest computed tomography (CT) showed multiple ground-glass lung opacities suggestive of septic pulmonary emboli. As central line-associated bloodstream infection was suspected, empirical antibiotics were initiated and the Groshong line was removed. The Gram-positive bacillus was later confirmed by the reference laboratory as Gordonia sputi via 16S rRNA sequencing. Vancomycin and ciprofloxacin for a duration of 6 weeks were completed as targeted antimicrobial therapy. After treatment, the patient remained symptom-free with marked improvement on repeat CT chest imaging.
Conclusion. This case illustrates the challenges surrounding identification of Gordonia spp. and other aerobic actinomycetes. 16S rRNA gene sequencing may be a preferred identification method, especially when initial workup of a weakly acid-fast organism fails to make an identification or shows discrepant results using traditional diagnostic modalities.
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Thank you for your revised manuscript. The reviewers are happy that all the comments posed were addressed and so I am now pleased to let you know that your manuscript has been accepted for publication.
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Comments to Author
All reviewer comments have been satisfactorily answered, and where appropriate, edited in text.
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community. Thank you for your submission and observations on this rare infection. Reviewers raised minor issues with the manuscript, please address them and we will be happy to accept the submission for publication.
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Comments to Author
73 - What is a normal neutrophil count range? 78 - Was vancomycin given to the patient following the results indicating it was a Gram positive organism, or beforehand? The Gram identity of the bacteria isn't given until line 80 101 - 16s rRNA sequencing can only identify down to genus level, not species (Fox, et al., 1992, doi:10.1099/00207713-42-1-166) Table 1 - Sex shows 86 people, however 92 total people in pooled studies 152-155 - Contradictory statements; 32.6% of studies didn't identify species, but 87% of studies used 16s rRNA sequencing 162 - Capital G for Gram
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns …
Comments to Author
73 - What is a normal neutrophil count range? 78 - Was vancomycin given to the patient following the results indicating it was a Gram positive organism, or beforehand? The Gram identity of the bacteria isn't given until line 80 101 - 16s rRNA sequencing can only identify down to genus level, not species (Fox, et al., 1992, doi:10.1099/00207713-42-1-166) Table 1 - Sex shows 86 people, however 92 total people in pooled studies 152-155 - Contradictory statements; 32.6% of studies didn't identify species, but 87% of studies used 16s rRNA sequencing 162 - Capital G for Gram
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
-
Comments to Author
1. Description of the case(s) The authors report a case of a rare human infection by Gordonia spp. in a renal transplant patient. While antibiotic therapy resolved the clinical issues, there wereissues and confusion surrounding clinical identification of the organism. This led the authors to carry out a literature review to assess of how common the issue is and suggest the use of 16S-rRNA sequencing as a standard. While this is a fair assessment, it should be made clear that 16s sequencing is often not suitable for distinguishing species level differences as the authors suggest in the manuscript. While still useful and a relative standard for microbial identification this limitation should be noted for case to case examples. 2. Presentation of results The results are presented satisfactorily. 3. …
Comments to Author
1. Description of the case(s) The authors report a case of a rare human infection by Gordonia spp. in a renal transplant patient. While antibiotic therapy resolved the clinical issues, there wereissues and confusion surrounding clinical identification of the organism. This led the authors to carry out a literature review to assess of how common the issue is and suggest the use of 16S-rRNA sequencing as a standard. While this is a fair assessment, it should be made clear that 16s sequencing is often not suitable for distinguishing species level differences as the authors suggest in the manuscript. While still useful and a relative standard for microbial identification this limitation should be noted for case to case examples. 2. Presentation of results The results are presented satisfactorily. 3. How the style and organization of the paper communicates and represents key findings While the literature review has been thorough, the presentation of the supplmentary data is very dense. Understandable for the type of work carried out but in future, may be more suitable in a more human readable short form though not a significant issue. 4. Literature analysis or discussion Thorough and draws useful conclusions that will be of interest to the field. 5. Any other relevant comments Minor issues: Line 45-46: This is an inappropriate reference for the comment, when the title of reference 1 is about Gordonia as an emerging pathogen. I suggest changing the wording of the sentence. Line 89: Please elaborate on E-test and its parameters.
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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