A case of diabetic foot ulcers complicated by severe infection and sepsis with Trueperella bernardiae

Introduction: Matrix‐assisted laser desorption/ionization time‐of‐flight mass spectrometry (MALDI‐TOF MS) allows us to identify bacteria directly from positive blood cultures with detailed taxonomy naming of the bacterial strains. Knowing the name of the infective bacteria makes it possible to adjust the antibiotic therapy early on. However, it also gives rise to detection of a number of unusual pathogens, which raises new questions on the pathogenicity and medical importance of a number of rarely isolated bacteria such as Trueperella bernardiae. Case presentation: We describe a case of diabetic foot ulcers in a 45‐year‐old male, which led to below‐the‐knee amputation due to widespread infection and sepsis with T. bernardiae and co‐infection with Peptoniphilus lacrimalis. The patient was treated initially with surgical debridement in combination with piperacillin/tazobactam and thereafter with amoxicillin for a total period of 1 month. Conclusion: Based on this case, as well as previous case reports in the literature, we conclude that T. bernardiae is a rarely isolated low‐pathogenic bacterium in patients with severe co‐morbidities. Often co‐infection with other low‐pathogenic bacteria is observed. T. bernardiae is susceptible to and readily treated with β‐lactam antibiotics.

[1]  P. Gérôme,et al.  Infection sous-cutanée à Trueperella bernardiae compliquée d’une bactériémie , 2013 .

[2]  P. Gérôme,et al.  [Trueperella bernardiae soft tissue infection and bacteremia]. , 2013, Medecine et maladies infectieuses.

[3]  M. Kostrzewa,et al.  Identification of Trueperella (Arcanobacterium) bernardiae by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry analysis and by species-specific PCR. , 2012, Journal of medical microbiology.

[4]  A. F. Yassin,et al.  Comparative chemotaxonomic and phylogenetic studies on the genus Arcanobacterium Collins et al. 1982 emend. Lehnen et al. 2006: proposal for Trueperella gen. nov. and emended description of the genus Arcanobacterium. , 2011, International journal of systematic and evolutionary microbiology.

[5]  K. Schønning,et al.  Using MALDI-TOF mass spectrometry as a rapid and accurate diagnostic tool in infective endocarditis: A case report of a patient with mitral valve infective endocarditis caused by Abiotrophia defectiva , 2011, Scandinavian journal of infectious diseases.

[6]  T. Weitzel,et al.  Arcanobacterium bernardiae bacteremia in a patient with deep soft tissue infection. , 2011, Surgical infections.

[7]  D. Citron,et al.  The conundrum of the gram-positive rod: are we missing important pathogens in complicated skin and soft-tissue infections? A case report and review of the literature. , 2010, Surgical infections.

[8]  R. Courcol,et al.  An unusual case of prosthetic joint infection due to Arcanobacterium bernardiae. , 2009, Journal of medical microbiology.

[9]  S. Corvec,et al.  A case of osteitis due to Staphylococcus aureus and Arcanobacterium bernardiae coinfection. , 2009, Diagnostic microbiology and infectious disease.

[10]  R. Heller,et al.  Urinary tract infection due toArcanobacterium bernardiae in a patient with a urinary tract diversion , 1998, European Journal of Clinical Microbiology and Infectious Diseases.

[11]  K. Carroll,et al.  Septic arthritis due to Arcanobacterium bernardiae in an immunocompromised patient. , 1998, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  M. Collins,et al.  Phylogenetic analysis of the genus Actinomyces based on 16S rRNA gene sequences: description of Arcanobacterium phocae sp. nov., Arcanobacterium bernardiae comb. nov., and Arcanobacterium pyogenes comb. nov. , 1997, International journal of systematic bacteriology.

[13]  H. Goossens,et al.  Severe infection due to Actinomyces bernardiae: case report. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  M. Collins,et al.  Description of human-derived Centers for Disease Control coryneform group 2 bacteria as Actinomyces bernardiae sp. nov. , 1995, International journal of systematic bacteriology.

[15]  C. W. Moss,et al.  Comparison of biochemical, morphologic, and chemical characteristics of Centers for Disease Control fermentative coryneform groups 1, 2, and A-4 , 1987, Journal of clinical microbiology.