title: Brevundimonas vesicularis bacteremia resistant to trimethoprim-sulfamethoxazole and ceftazidime in a tertiary hospital in southern Taiwan.
abstract: BACKGROUND
  Over the past 20 years, Brevundimonas vesicularis has rarely been reported as a pathogen causing human infection. The clinical manifestations of B. vesicularis bacteremia and its susceptibility to antibiotics has not been characterized.
  
  
  METHODS
  A retrospective study was conducted between 2006 and 2009 in a tertiary-care hospital in southern Taiwan.
  
  
  RESULTS
  A total of 22 cases of B. vesicularis bacteremia were identified during the study with 86% being community-acquired primary bloodstream infections. Of the 22 patients, 15 (68%) presented with fever, fewer comorbidities, shorter hospital stays, lower mean creatinine levels (1.10 mg/dL vs. 1.74 mg/dL), lower aspartate aminotransferase levels (29.1 IU/L vs. 79.0 IU/L), and lower alanine aminotransferase levels (16.4 IU/L vs. 67.0 IU/L) when compared to afebrile patients. Among the bacterial isolates, 90.9% were susceptible to cefpirome, imipenem and piperacillin/tazobactam while 86.4% were susceptible to gentamicin, amikacin and ciprofloxacin. However, 63.6% of the bacterial isolates were susceptible to ceftazidime, and only 59.1% were susceptible to trimethoprim-sulfamethoxazole (TMP-SMX). The 30-day mortality rate from all causes was 4.5%.
  
  
  CONCLUSIONS
  B. vesicularis is able to cause community-acquired and low-mortality primary bloodstream infections. The resistance of B. vesicularis to trimethoprim-sulfamethoxazole and ceftazidime limits the choice of available antibiotics for treatment.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan.
authors.forename: Chun-Cheng
authors.initials: CC
authors.lastname: Zhang
authors.forename: Hui-Jine
authors.initials: HJ
authors.lastname: Hsu
authors.forename: Chien-Ming
authors.initials: CM
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D042063:Caulobacteraceae / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D002442:Ceftazidime / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000494:pharmacology*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination; D002442:Ceftazidime