title: Achromobacter buckle infection diagnosed by a 16S rDNA clone library analysis: a case report.
abstract: BACKGROUND
  In clinical settings, bacterial infections are usually diagnosed by isolation of colonies after laboratory cultivation followed by species identification with biochemical tests. However, biochemical tests result in misidentification due to similar phenotypes of closely related species. In such cases, 16S rDNA sequence analysis is useful. Herein, we report the first case of an Achromobacter-associated buckle infection that was diagnosed by 16S rDNA sequence analysis. This report highlights the significance of Achromobacter spp. in device-related ophthalmic infections.
  
  
  METHODS
  A 56-year-old woman, who had received buckling surgery using a silicone solid tire for retinal detachment eighteen years prior to this study, presented purulent eye discharge and conjunctival hyperemia in her right eye. Buckle infection was suspected and the buckle material was removed. Isolates from cultures of preoperative discharge and from deposits on the operatively removed buckle material were initially identified as Alcaligenes and Corynebacterium species. However, sequence analysis of a 16S rDNA clone library using the DNA extracted from the deposits on the buckle material demonstrated that all of the 16S rDNA sequences most closely matched those of Achromobacter spp. We concluded that the initial misdiagnosis of this case as an Alcaligenes buckle infection was due to the unreliability of the biochemical test in discriminating Achromobacter and Alcaligenes species due to their close taxonomic positions and similar phenotypes. Corynebacterium species were found to be contaminants from the ocular surface.
  
  
  CONCLUSIONS
  Achromobacter spp. should be recognized as causative agents for device-related ophthalmic infections. Molecular species identification by 16S rDNA sequence analysis should be combined with conventional cultivation techniques to investigate the significance of Achromobacter spp. in ophthalmic infections.
authors.forename: Fumika
authors.initials: F
authors.lastname: Hotta
authors.affiliation: Department of Ophthalmology, Institute of Health Biosciences, The University of Tokushima Graduate School, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan. hiroegu0113@gmail.com.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Eguchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Naito
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Mitamura
authors.forename: Kohei
authors.initials: K
authors.lastname: Kusujima
authors.forename: Tomomi
authors.initials: T
authors.lastname: Kuwahara
mesh_terms: D042402:Achromobacter / Q000235:genetics / Q000302:isolation & purification*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001623:Betamethasone / Q000627:therapeutic use; D000077525:Cefdinir; D002511:Cephalosporins / Q000627:therapeutic use; D004269:DNA, Bacterial / Q000235:genetics; D004275:DNA, Ribosomal / Q000235:genetics*; D020878:Device Removal; D004359:Drug Therapy, Combination; D015818:Eye Infections, Bacterial / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D016905:Gram-Negative Bacterial Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D008875:Middle Aged; D000077266:Moxifloxacin; D016133:Polymerase Chain Reaction; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D012163:Retinal Detachment / Q000601:surgery; D012591:Scleral Buckling
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D024841:Fluoroquinolones; D005938:Glucocorticoids; D012336:RNA, Ribosomal, 16S; D001623:Betamethasone; D000077525:Cefdinir; D000077266:Moxifloxacin