Related Experiment Videos
Infection due to Leuconostoc species: six cases and review
S Handwerger1, H Horowitz, K Coburn
1Division of Infectious Diseases, Beth Israel Medical Center, Mount Sinai School of Medicine, New York, New York.
Abstract:
Leuconostocs, members of the family Streptococcacae, have only recently been recognized as potential pathogens. We describe six cases of leuconostoc bacteremia and review 11 additional cases of infection reported in the literature. Fifteen patients with bacteremia ranged from neonates to persons aged 78 years. Almost all were hospitalized with significant underlying diseases, had received previous antibiotic therapy, and had undergone procedures that interrupted the normal integumentary defense. Leuconostoc bacteremia was associated with fever, leukocytosis, and gastrointestinal complaints. Eight of 15 patients had polymicrobial bacteremia, seven of these eight with staphylococcal species. Clinical isolates of Leuconostoc were frequently misidentified, usually as viridans streptococci. All clinical isolates identified to date--and most agricultural isolates--demonstrate a high level of resistance to vancomycin. Successful regimens for treatment of Leuconostoc include high-dose penicillin, clindamycin, and where appropriate, removal of infected intravascular catheters. Susceptibility testing of all gram-positive bacteria isolated from normally sterile body sites is recommended.
Insights
Leuconostoc bacteremia, a rare infection, often occurs in hospitalized patients with underlying conditions. These bacteria are frequently misidentified and show high vancomycin resistance, necessitating susceptibility testing.
Area of Science:
- Medical Microbiology
- Infectious Diseases
Background:
- Leuconostocs, part of the Streptococcaceae family, are increasingly recognized as opportunistic pathogens.
- This study details six cases of Leuconostoc bacteremia and reviews eleven previously reported cases.
Observation:
- The study population included 15 patients, ranging from neonates to the elderly, with significant underlying diseases and compromised integumentary defenses.
- Common clinical presentations included fever, leukocytosis, and gastrointestinal issues.
- Polymicrobial bacteremia was noted in eight patients, often involving Staphylococcus species.
Findings:
- Clinical Leuconostoc isolates were frequently misidentified as viridans streptococci.
- A high level of vancomycin resistance was observed in both clinical and agricultural Leuconostoc isolates.
- Effective treatments involved high-dose penicillin, clindamycin, and intravascular catheter removal.
Implications:
- Accurate identification and susceptibility testing of Gram-positive bacteria from sterile sites are crucial.
- Understanding Leuconostoc's resistance patterns informs clinical management and treatment strategies.
- This highlights the need for vigilance regarding emerging pathogens in immunocompromised populations.