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Peripherally inserted central catheter-related bloodstream infection caused by Kocuria marina in an elderly man
Nobuaki Mori1, Yuichi Nishihara2, Hideki Tayama2
1Department of General Internal Medicine, National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 152-8902, Japan. noubaki.m@icloud.com.
Background:
Kocuria species are Gram-positive, aerobic cocci, and members of the Micrcoccaceae family that are known to be opportunistic pathogens. Although there have been sporadic reports of infections caused by Kocuria species, little is known regarding their human pathogenicity and clinical characteristics.
Case Report:
We herein report a case of a peripherally inserted central catheter (PICC)-related bloodstream infection caused by Kocuria marina in a 90-year-old Japanese with multiple cancer. The patient, who was admitted due to adhesive intestinal obstruction, suddenly developed sepsis on day 29 following admission. Three sets of blood cultures and a culture of the PICC tip revealed the growth of Gram-positive cocci arranged in clusters. The patient improved quickly after treatment with an antimicrobial agent and catheter removal. The organism was identified as Kocuria varians using the MicroScan Walkaway system and K. varians/Kocuria rosea with a 99.7% probability using an API Staph system. However, 16S rRNA gene sequencing analysis identified the pathogen as K. marina.
Conclusion:
Although K. marina is a rare pathogen, physicians should consider it in case of catheter-related infections in patients with serious underlying conditions. As commercial identification systems can misidentify species within the Kocuria genus, the use of genomic methods such as 16S rRNA sequencing and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry may be useful for the precise identification of Kocuria to the species level.
Insights
Kocuria marina caused a rare catheter-related bloodstream infection in an elderly patient with cancer. Accurate species identification is crucial, as standard methods may misidentify Kocuria, necessitating genomic approaches.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Kocuria species are opportunistic Gram-positive cocci.
- Human pathogenicity and clinical features of Kocuria remain poorly understood.
- Sporadic infections have been reported, highlighting their potential as pathogens.
Observation:
- A 90-year-old patient with multiple cancers developed sepsis associated with a peripherally inserted central catheter (PICC).
- Blood cultures and PICC tip cultures yielded Gram-positive cocci.
- Initial identification using commercial systems suggested Kocuria varians or Kocuria rosea.
Findings:
- 16S rRNA gene sequencing definitively identified the causative agent as Kocuria marina.
- The patient recovered following antimicrobial therapy and catheter removal.
- Commercial identification systems demonstrated limitations in accurately differentiating Kocuria species.
Implications:
- Kocuria marina should be considered in catheter-related infections, especially in immunocompromised or critically ill patients.
- Accurate species-level identification of Kocuria is essential for appropriate patient management.
- Genomic techniques like 16S rRNA sequencing and MALDI-TOF MS are valuable for precise Kocuria identification, overcoming limitations of traditional methods.
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