Tsukamurella tyrosinosolvens에 의한 카테터 관련 혈류감염 1예
A Case of Catheter-Related Bloodstream Infection Caused by Tsukamurella tyrosinosolvens
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Tsukamurella 속은 주로 토양에서 관찰되며 드물게 인체감염을 유발하는 호기성 방선균이다. 본 연구에서 저자들은 T. tyrosinosolvens에 의한 카테터 관련 혈류감염 1예를 보고하고자 한다. 재가 정맥영양요법을 위해 중심정맥관을 가지고 있는 8세 여아가 내원일 발생한 발열로 응급실을 통해 입원하였다. 입원일에 시행한 세 쌍의 혈액배양 중 두 개의 호기성 혈액배양병에서 그람양성막대균이 관찰되었다. 해당 균주는 VITEK 2 (bioMérieux, USA)로 동정되지 않았으나 microflex LT (Bruker Daltonics, Germany)로 matrix-assisted laser desorption ionization time-of flight mass spectrometry (MALDI-TOF MS) 검사를 시행하여 Tsukamurella 속으로 동정되었다. 해당 균주의 16S rRNA 염기서열분석 결과 T. tyrosinosolvens, T. hominis 및 T. ocularis에 대해 모두 99.7% 이상의 일치도를 보였다. Tsukamurella 속의 16S rRNA 염기서열은 종간 다양성이 낮아 종 수준 감별이 어려워, 추가로 해당 균주의 groEL 유전자 염기서열분석을 시행했고, T. tyrosinosolvens에 대해 99.51% 일치도를 보였다. 환자는 초기 vancomycin, piperacillin/tazobactam를 포함한 항생제를 투여받았다. 입원 2일째 시행한 3쌍의 혈액배양 중 1쌍의 중심정맥 혈액배양에서만 T. tyrosinosolvens가 관찰되었고, 이후 3회의 연속된 추적 말초혈액 배양에서 미생물이 관찰되지 않았다. 본 증례는 T. tyrosinosolvens에 의한 카테터 관련 혈류감염의 국내 첫 보고이다. 이 연구는 Tsukamurella 속 균의 정확한 동정을 위해 groEL 유전자 염기서열분석이 유용함을 입증했다.
Abstract
The genus Tsukamurella is an aerobic actinomycete found in soil, and rarely infects humans. Herein, we report a case of catheter-related bloodstream infection caused by T. tyrosinosolvens. An 8-year-old girl with a central line for home parenteral nutrition was admitted via the emergency room due to fever. Gram-positive bacilli were detected in two aerobic blood culture bottles among the three pairs of blood cultures. The isolate was not identified by VITEK 2 (bioMérieux, USA) but was identified as Tsukamurella spp. by matrix-assisted laser desorption ionization time-of-flight mass spectrometry using the microflex LT (Bruker Daltonics, Germany). The 16S rRNA sequences of these bacteria indicated over 99.73% identity match with T. tyrosinosolvens, T. hominis, and T. ocularis. The groEL gene was sequenced because of low interspecies 16S rRNA sequence variability in the genus Tsukamurella. The isolate showed 99.51% identity with T. tyrosinosolvens. The patient was treated with antibiotics, including vancomycin and piperacillin/tazobactam. T. tyrosinosolvens was detected in one aerobic blood culture bottle among the three pairs of blood cultures on the second day of hospital stay. Three sequential follow-up blood cultures were negative for the microorganisms. To our knowledge, this is the first report of catheter-related bloodstream infection caused by T. tyrosinosolvens in Korea. This study demonstrated the usefulness of groEL gene sequencing for accurate identification of Tsukamurella spp.
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