[Emergence of beta-lactam-dependent Bacillus cereus associated with prolonged treatment with cefepime in a neutropenic patient].
Antibiotic dependence in clinical isolates has been reported, albeit rarely, such as vancomycin-dependent enterococcus and beta-lactam-dependent Staphylococcus saprophyticus. We report herein a clinical isolate of beta-lactam-dependent Bacillus cereus. A 16-yr-old female was admitted on 8 September 2005 with neutropenic fever during chemotherapy following surgical removal of peripheral neuroectodermal tumor. She had had an indwelling chemoport since August 2004 and experienced B. cereus bacteremia three times during the recent 3-month period prior to the admission; the bacteremias were treated with cefepime-based chemotherapy. On hospital days 1 and 3, B. cereus was isolated from blood drawn through the chemoport. The isolates were resistant to penicillin, ceftriaxone, and erythromycin, and susceptible to vancomycin and ciprofloxacin. The isolate of hospital day 3 grew only nearby the beta-lactam disks including penicillin and ceftriaxone on disk diffusion testing. The beta-lactam-dependent isolate required a minimum of 0.064 microg/mL of penicillin or 0.023 microgram/mL of cefotaxime for growth, which was demonstrated by E test (AB Biodisk, Sweden). Light microscopy and transmission electron microscopy revealed a marked elongation of the dependent strain compared with the non-dependent strain. Prolonged therapy with beta-lactams in the patient with an indwelling intravenous catheter seemed to be a risk factor for the emergence of beta-lactam-dependence in B. cereus.
Ko
Sun-Young
SY
Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea.
Chung
Hee-Jung
HJ
Sung
Heong-Sup
HS
Kim
Mi-Na
MN
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016863:Bacillaceae Infections / Q000188:drug therapy* / Q000382:microbiology; D001409:Bacillus cereus / Q000166:cytology / Q000187:drug effects* / Q000302:isolation & purification; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008826:Microbial Sensitivity Tests; D009503:Neutropenia / Q000150:complications* / Q000209:etiology; D012307:Risk Factors; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime