Bacillus Cereus’un Etken Olduğu Kateter İlişkili Kan Akımı Enfeksiyonu

Abstract

Bacillus cereus hava, su ve toprakta bol miktarda bulunan fakültatif aerop, gram pozitif bir basildir. Klinik örneklerde izole edildiğinde genellikle kontaminant olarak yorumlanır. Ancak günümüzde özellikle immün yetersizliği olan, kemo- terapi alan, hastanede uzun süre yatan ve invaziv işlemler yapılan hastalarda sağlık bakımı ilişkili enfeksiyon etkeni olarak raporlanmaya başlanmıştır. Bu vakayı Bacillus cereus’un patogenisitesi ile ilgili hekimlerimizin duyarlılı- ğını artırmak amacı sunduk. Akut lenfositer lösemi ALL tanılı 18 aylık, kız hastaya nötropenik olmayan ateş tanısı ile piperacillin-tazobaktam başlandı. Hastanın kateter kan kültüründe Bacillus cereus üredi. Bacillus türleri penisiline dirençli olduğundan piperacillin-tazobaktam tedavisiyle ateşi devam etti, tedaviye teikoplanin eklendi. Ekokardiyografide infektif endokardit bulgusu yoktu, güna- şırı alınan perifer ve kateter kan kültürlerinde Bacillus cereus üremesi devam ettiği için kateteri çekildi. Kateterin çekilmesi ile hastanın ateşi düştü. Sonuç olarak Bacillus cereus’un kan kültüründe üremesinin sağlık bakımı ilişkili enfeksiyon etkeni olarak karşımıza çıkabileceği unutulma- malı, her zaman kontaminasyon olarak değerlendirilmeme- lidir. Yine Bacillus türleri penisilin dirençli olduğu için, komplikasyonların gelişmesini önlemek için tedavi vanko- misin ve/veya amikasin şeklinde düzenlenmelidir

Keywords

• Bacillus cereus,kateter,bakteriyemi

Catheter Related Blood Stream Infection Caused by Bacillus Cereus

Abstract

Bacillus cereus is a facultative aerobic gram positive bacilli which is abundantly found in air, water and soil. It is usually interpreted as contamination when it is isolated from clinical specimens. Recently, it has been, reported as health-care associated infectious agent HAIA in pati- ents with immune deficiency, receiving chemotherapy, with prolonged hospitalization and who had been perfor- med invasive procedures. This case was reported in order to increase the awareness of clinicians for the pathogeni- city of Bacillus cereus. Piperacillin- tazobactam was started for non-neutropenic fever to an 18-month old girl with acute lymphocytic leukemia. Her catheter-drawn blood sample revealed Bacillus cereus growth. Teicoplanin was added to therapy for unremitting fever, since Bacillus species are resistant to penicillin. Echocardiography did not reveal any sign of infective endocarditis. Her catheter was withdrawn since repeated peripheric and catheter drawn blood samples yielded Bacillus cereus growth on alternate days. Her fever dropped after the catheter was withdrawn. In conclusion, it must be remembered that Bacillus cereus can be a HAIA and should not be always interpereted as contamination. Besides, since Bacillus species are resistant to penicilline derivatives, therapy should be held as vancomycine and/or amikacin

Keywords

• Bacillus cereus,catheter,bacteriemia

References

1. Drobniewski FA. Bacillus cereus and related species. Clin Microbiol Rev 1993;6:324-38. https://doi.org/10.1128/CMR.6.4.324
2. Zinner SH. Changing epidemiology of infections with neutropenia and cancer: emphasis on gram positive and resistant bacteria. Clin Infect Dis 1999;29:490-4. https://doi.org/10.1086/598620
3. musa mO, Al Douri m, Khan S, Shafi T, Aı Humaidh A, Aı rasheed Am. Fulminant septicaemic syndrome of Bacillus cereus: three case reports. J Infect 1999;39:154-6. https://doi.org/10.1016/S0163-4453(99)90009-9
4. Hernaiz c, Picardo A, Alos Jı, gomez-garces Jl. Nosocomial bacteremia and catheter infection by Bacillus cereus in an immunocompetent patient. Clin Microbiol Infect 2003;9:973-5. https://doi.org/10.1046/j.1469-0691.2003.00682.x
5. gurler n, Oksuz l, muftuoğlu m, Sargin F, Bessisik S. Bacillus cereus catheter related bloodstream infecti- on in a patient with acute lymphoblastic leukemia. Mediterr J Hematol Infect Dis 2012;4:e2012004. https://doi.org/10.4084/mjhid.2012.004
6. Weber DJ, Saviteer Sm, rutala WA, Thomann cA. Clinical significance of Bacillus species isolated from blood cultures. South Med J 1989;82:705. https://doi.org/10.1097/00007611-198906000-00008
7. Ash c, Farrow JA, Dorsch m, Stackenbrandt E, collins mD. Comparative analysis of Bacillus anthra- cis, Bacillus cereus, and related species on the basis of reverse transcriptase sequencing of 16S rRNA. Int J Syst Bacteriol 1991;41:343-6. https://doi.org/10.1099/00207713-41-3-343
8. Bottone EJ. Bacillus cereus, a volatile human patho- gen. Clin Microbiol Rev 2010;23:382-98. https://doi.org/10.1128/CMR.00073-09

9. Akiyama n, mitani K, Tanaka y, et al. Fulminant septicemic syndrome of Bacillus cereus in a leukemic patient. Intern Med 1997;36:221-6. https://doi.org/10.2169/internalmedicine.36.221
10. ginsburg A, Salazar lg, True lD, Disis ml. Fatal Bacillus cereus sepsis following resolving neutropenic enterocolitis during the treatment of acute leukemia. Am J Hematol 2003;72:204-8. https://doi.org/10.1002/ajh.10272
11. Tuladhar r, Patole SK, Kok TH, norton r, Whitehall JS. Refractory Bacillus cereus infection in a neonate. Int J Clin Pract 2000;54:345-7.