title: Differences in Rhodococcus equi Infections Based on Immune Status and Antibiotic Susceptibility of Clinical Isolates in a Case Series of 12 Patients and Cases in the Literature.
abstract: Rhodococcus equi is an unusual zoonotic pathogen that can cause life-threatening diseases in susceptible hosts. Twelve patients with R. equi infection in Kentucky were compared to 137 cases reported in the literature. Although lungs were the primary sites of infection in immunocompromised patients, extrapulmonary involvement only was more common in immunocompetent patients (P < 0.0001). Mortality in R. equi-infected HIV patients was lower in the HAART era (8%) than in pre-HAART era (56%) (P < 0.0001), suggesting that HAART improves prognosis in these patients. Most (85-100%) of clinical isolates were susceptible to vancomycin, clarithromycin, rifampin, aminoglycosides, ciprofloxacin, and imipenem. Interestingly, there was a marked difference in susceptibility of the isolates to cotrimoxazole between Europe (35/76) and the US (15/15) (P < 0.0001). Empiric treatment of R. equi infection should include a combination of two antibiotics, preferably selected from vancomycin, imipenem, clarithromycin/azithromycin, ciprofloxacin, rifampin, or cotrimoxazole. Local antibiograms should be checked prior to using cotrimoxazole due to developing resistance.
authors.affiliation: University of Kentucky, Lexington, KY 40536, USA.
authors.forename: Praveen
authors.identifier: 0000-0003-4223-0712
authors.initials: P
authors.lastname: Gundelly
authors.affiliation: University of Kentucky, Lexington, KY 40536, USA.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Suzuki
authors.affiliation: University of Kentucky, Lexington, KY 40536, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Ribes
authors.affiliation: University of Kentucky, Lexington, KY 40536, USA.
authors.forename: Alice
authors.initials: A
authors.lastname: Thornton
mesh_terms: D000193:Actinomycetales Infections / Q000188:drug therapy / Q000276:immunology* / Q000382:microbiology* / Q000401:mortality; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D003710:Demography; D005260:Female; D006801:Humans; D007121:Immunocompetence / Q000187:drug effects; D016867:Immunocompromised Host; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009928:Organ Specificity; D016929:Rhodococcus equi / Q000187:drug effects* / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents