Lactobacillus bacteremia, species identification, and antimicrobial susceptibility of 85 blood isolates.

BACKGROUND Data regarding antimicrobial susceptibility of clinical Lactobacillus isolates are scarce, and appropriate interpretation criteria for susceptibility tests are not available. METHODS We examined 85 cases of Lactobacillus bacteremia, of which 47 cases have been included in our previous studies. Overall, 14 antimicrobial agents were evaluated by the E-test method, and these results were compared with disk diffusion test findings. The clinical outcomes of the patients and their antimicrobial treatments were registered. RESULTS The antimicrobial susceptibility of Lactobacillus strains was species dependent. The considerable number of Lactobacillus rhamnosus (n=46), Lactobacillus fermentum (n=12), and Lactobacillus casei (n=12) strains available for testing made it possible to compare the susceptibilities within 1 species, as well. Of the 46 L. rhamnosus isolates, 22 were identified as L. rhamnosus GG type by pulsed-field gel electrophoresis. All Lactobacillus isolates demonstrated low minimum inhibitory concentrations (MICs) of imipenem, piperacillin-tazobactam, erythromycin, and clindamycin. MICs of vancomycin were high (>256 microg/mL) for all other species except Lactobacillus gasseri and Lactobacillus jensenii. Disk diffusion and E-test results were concordant. The MICs of cephalosporins varied; cefuroxime demonstrated a higher level of activity than did ceftriaxone. Benzylpenicillin and ampicillin MICs had variable ranges between different species. Combination therapy was given to 83% of the patients, but, in 54% of them, therapy included only 1 microbiologically active agent, according to results of the susceptibility tests. Mortality at 1 week was 12% among patients who presumably were receiving adequate treatment and 27% among patients who were receiving inadequate treatment (P=.131, by E-test). CONCLUSION Most clinical Lactobacillus blood isolates demonstrated low MICs of imipenem, piperacillin-tazobactam, erythromycin, and clindamycin, but they had variable susceptibility to penicillin and cephalosporins.

[1]  P. Brouqui,et al.  Use of 16S rRNA gene sequencing to identifyLactobacillus casei in septicaemia secondary to a paraprosthetic enteric fistula , 1998, European Journal of Clinical Microbiology and Infectious Diseases.

[2]  A. Stamatoullas,et al.  Lactobacillus species as emerging pathogens in neutropenic patients , 1997, European Journal of Clinical Microbiology and Infectious Diseases.

[3]  D. Espinouse,et al.  Lactobacillus rhamnosus septicemia in patients with prolonged aplasia receiving ceftazidime-vancomycin , 2005, European Journal of Clinical Microbiology and Infectious Diseases.

[4]  S. Mitsuhashi.  Drug resistance plasmids , 1979, Molecular and Cellular Biochemistry.

[5]  J. Bartlett,et al.  False-positive gonorrhea test results with a nucleic acid amplification test: The impact of low prevalence on positive predictive value , 2004 .

[6]  M. Saklayen,et al.  Lactobacillus paracasei Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis and Review of the Literature , 2003, Journal of Clinical Microbiology.

[7]  M. Danielsen,et al.  Susceptibility of Lactobacillus spp. to antimicrobial agents. , 2003, International journal of food microbiology.

[8]  Maija Saxelin,et al.  Lactobacillus bacteremia during a rapid increase in probiotic use of Lactobacillus rhamnosus GG in Finland. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[9]  R. Dessein,et al.  Molecular diagnosis of endocarditis due to Lactobacillus casei subsp. rhamnosus. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  L. Morelli,et al.  Gradient diffusion antibiotic susceptibility testing of potentially probiotic lactobacilli. , 2001, Journal of food protection.

[11]  A. Katla,et al.  Antimicrobial susceptibility of starter culture bacteria used in Norwegian dairy products. , 2001, International journal of food microbiology.

[12]  F. Baquero,et al.  In Vitro Activities of Ketolide HMR3647, Macrolides, and Other Antibiotics against Lactobacillus,Leuconostoc, and PediococcusIsolates , 1999, Antimicrobial Agents and Chemotherapy.

[13]  C. Bizet,et al.  Lactobacillus Species Identification, H2O2 Production, and Antibiotic Resistance and Correlation with Human Clinical Status , 1999, Journal of Clinical Microbiology.

[14]  L. Morelli,et al.  Antibiotic susceptibility of potentially probiotic Lactobacillus species. , 1998, Journal of food protection.

[15]  J. Hamilton-miller,et al.  Vancomycin Susceptibility as an Aid to the Identification of Lactobacilli , 1998, Letters in Applied Microbiology.

[16]  J. Washington,et al.  Lactobacillus bacteremia and endocarditis: review of 45 cases. , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[17]  L. Morelli,et al.  Selective detection, enumeration and identification of potentially probiotic Lactobacillus and Bifidobacterium species in mixed bacterial populations. , 1997, International journal of food microbiology.

[18]  C. Stratton,et al.  Lactobacillus bacteremia: description of the clinical course in adult patients without endocarditis. , 1996, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[19]  C. Cerniglia,et al.  PCR detection and quantitation of predominant anaerobic bacteria in human and animal fecal samples , 1996, Applied and environmental microbiology.

[20]  D. Durack,et al.  New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. , 1994, The American journal of medicine.

[21]  F. Gasser,et al.  Safety of lactic acid bacteria and their occurrence in human clinical infections , 1994 .

[22]  M. Collins,et al.  Lactic acid bacteria and human clinical infection. , 1993, The Journal of applied bacteriology.

[23]  I. Brook,et al.  Significant recovery of nonsporulating anaerobic rods from clinical specimens. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[24]  D. Sanyal,et al.  CAPD peritonitis caused by Lactobacillus rhamnosus. , 1992, The Journal of hospital infection.

[25]  C. Bantar,et al.  Abscess caused by vancomycin-resistant Lactobacillus confusus , 1991, Journal of clinical microbiology.

[26]  R. Facklam,et al.  Antimicrobial susceptibility of vancomycin-resistant Leuconostoc, Pediococcus, and Lactobacillus species , 1990, Antimicrobial Agents and Chemotherapy.

[27]  L. Morelli,et al.  Drug resistance plasmids in Lactobacillus acidophilus and Lactobacillus reuteri , 1982, Applied and environmental microbiology.

[28]  A. Chow,et al.  Comparative In Vitro Activity of Five Cephalosporins Against Lactobacilli , 1979, Antimicrobial Agents and Chemotherapy.

[29]  A. Chow,et al.  Susceptibility of 40 Lactobacilli to Six Antimicrobial Agents with Broad Gram-Positive Anaerobic Spectra , 1978, Antimicrobial Agents and Chemotherapy.

[30]  A. Chow,et al.  Lactobacillemia--report of nine cases. Important clinical and therapeutic considerations. , 1978, The American journal of medicine.