Buscar en
Enfermedades Infecciosas y Microbiología Clínica
Toda la web
Inicio Enfermedades Infecciosas y Microbiología Clínica Arthrobacter creatinolyticus: An emerging human pathogen causing urinary tract i...
Información de la revista
Vol. 38. Núm. 2.
Páginas 88-89 (Febrero 2020)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 38. Núm. 2.
Páginas 88-89 (Febrero 2020)
Scientific letter
DOI: 10.1016/j.eimc.2019.02.003
Acceso a texto completo
Arthrobacter creatinolyticus: An emerging human pathogen causing urinary tract infection
Arthrobacter creatinolyticus: un patógeno emergente en el ser humano causante de infecciones del tracto urinario
Visitas
...
Sandra Nabal Díaz, Juan M. García-Lechuz Moya
Autor para correspondencia
jmgarcialechuz@salud.aragon.es

Corresponding author.
, Saray Mormeneo Bayo, María Isabel Millán Lou
Servicio de Microbiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
Información del artículo
Texto completo
Bibliografía
Descargar PDF
Estadísticas
Figuras (1)
Tablas (1)
Table 1. Antimicrobial susceptibility profile of Arthrobacter creatinolyticus.
Texto completo

Arthrobacter creatinolyticus is a Gram-positive aerobic coccobacillus, catalase-positive, belonging to the family Micrococcaceae, order Actinomycetales, usually found in soil and in the environment. This organism produces urease, an extracellular enzyme with many industrial applications and a potential use in anti-cancer therapy due to its cytotoxic effect.1

We have only found in the literature one case of bacteremia due to this microorganism, and none confirmed as a cause of urinary tract infection. We present a case of urinary tract infection due to A. creatinolyticus.

A woman, in her ninety, came to the primary care with signs of agitation. The patient presented several pathologies as hypertension, diabetes, Parkinson's disease and vascular dementia. She was aggressive at the time of consultation and the exploration was complicated as well as the anamnesis that was unable to stablish the presence of urethral syndrome. In addition no urine test strip or sediment analysis was done. The caregiver confirmed that the patient did not had fever but she had been agitated for the past four days. On the suspicion of urinary infection, the doctor ordered a urine culture and prescribed fosfomycin empirically. After 24h of incubation in the chromogenic medium UTIR (Oxoid LTD, UK), >100,000CFU/mL of A. creatinolyticus were isolated (Fig. 1).

Fig. 1.

Colonies of Arthrobacter creatinolyticus grown in UTI® chromogenic agar.

(0,09MB).

The identification of the microorganism was performed by mass spectrometry using the MALDI-TOF Biotyper 3.1 (Bruker Daltonic GmbH, Bremen, Germany), resulting in A. creatinolyticus with a score of 2.3. This identification was confirmed by sequencing the 16 rRNA gene. To our surprise, the result was different: Glutamicibacter creatinolyticus. In fact, this is the same microorganism, being A. creatinolyticus its basonym (Hou et al., 1998),2 which has recently been reclassified into a new genus. The sequence was 99% indentical to G. creatinolyticus type strain KY814694.1 using the NCBI 16S rRNA gene database.

The susceptibility to antimicrobials was performed by disc diffusion test and also by broth microdilution method using the automated system MicroScan Walkaway (Beckman Coulter, USA) using the Pos MIC Panel Type 33. The interpretation of the minimum inhibitory concentrations (MICs) was performed according to the breakpoints for Corynebacterium spp. and related groups established by the Clinical and Laboratory Standards Institute (CLSI) (Table 1).

Table 1.

Antimicrobial susceptibility profile of Arthrobacter creatinolyticus.

Antibimicrobials  Disc diffusion Inhibition zone (mm)  MIC (μg/mL)  Clinical category 
Penicillin  30  <=0.12 
Ampicillin–Amoxicillin  30  <=0.25 
Amoxicillin/clavulanate  36  <=4/2 
Vancomycin  24  <=0.25 
Teicoplanin  26  <=1 
Gentamicin  24  <=1 
Linezolid  38  <=1 
Ciprofloxacin  25  <=1 
Levofloxacin  26  <=1 
Nitrofurantoin  64 
Fosfomycin  20  >64 
Trimethoprim–Sulfametoxazole  46  <=2/38 

CLSI criteria: S, susceptible; R, resistant.

After knowing the pattern of antimicrobial susceptibility, the treatment was changed to oral levofloxacin 250mg daily for five days. One week after the end of treatment and due to the persistence of the agitation, the doctor ordered a new urine culture. Again, the same microorganism was isolated (>100,000CFU/mL), and a new treatment was prescribed, with ciprofloxacin 250mg bid for two weeks.

In a third urine culture taken 3 weeks later, A. creatinolyticus was isolated once again in a lower count (less than 10,000CFU/mL) and the antimicrobial susceptibility profile remained unchanged. At this point, the clinical status of the patient had improved but she had developed a cystocele, and we considered that the organism was colonizing the urinary tract.

As we have previously mentioned, there is only one reported case of bacteremia due to this microorganism in an elderly person with diabetes and acute cholangitis.3 On the other hand, another case reported describes the isolation of A. creatinolyticus strains found in the urine of patients with neuroblastoma4 and low levels of creatinine in serum and urine. The authors emphasized that this bacterium possesses creatinase, an enzyme able to hydrolyze creatinine, but they did not find any clinical evidence of urinary infection caused by this organism.

In our patient, the existence of urinary tract infection based on the recent change on her clinical or functional status (acute confusional disorder, discomfort or agitation)5 was confirmed twice by the presence of significant bacteriuria due to A. creatinolyticus. The patient clinical status improved but finally developed a cystocele due to the weakening of the pelvic muscles indicating that the organism was colonizing the bladder of the patient.

Another species of this bacterium have also been described6,7 as the etiologic agents of urinary tract infection (A. albus, A. aurescens, A. cumminsii, A. protophormiae), and according to our case, we must include G. creatinolyticus (bfn. Arthrobacter) as an emerging pathogen causing urinary infection in the elderly.

References
[1]
R. Rajendran, A. Pandi, A. Ramchary, H. Thiagarajan, J. Panneerselvam, A. Niraikulam, et al.
Extracellular urease from Arthrobacter creatinolyticus MTCC 5604: scale up, purification and its cytotoxic effect thereof.
[2]
H.J. Busse.
Review of the taxonomy of the genus Arthrobacter, emendation of the genus Arthrobacter sensu-lato, proposal to reclassify selected species of the genus Arthrobacter in the novel genera Glutamicibacter gen. nov., Paeniglutamicibacter gen. nov., Pseudoglutamicibacter gen. nov., Paenarthrobacter gen. nov. and Pseudarthrobacter gen. nov., and emended description of Arthrobacter roseus.
Int J Syst Evol Microbiol, 66 (2016), pp. 9-37
[3]
K. Yamamoto, K. Hayakawa, M. Nagamatsu, Y. Fujiya, M. Mawatari, S. Kutsuna, et al.
Bacteremia due to Arthrobacter creatinolyticus in an elderly diabetic man with acute cholangitis.
Jpn J Infect Dis, 70 (2017), pp. 201-202
[4]
X.G. Hou, Y. Kawamura, F. Sultana, S. Shu, K. Hirose, K. Goto, et al.
Description of Arthrobacter creatinolyticus sp. nov., isolated from human urine.
Int J Syst Bacteriol, 48 (1998), pp. 423-429
[5]
C. Verdejo.
Peculiaridades de la infección urinaria en la persona mayor.
Actualización de la Infección urinaria en urología, 9788409025466, pp. 179-184
[6]
J. Mensa, J.M. Gatell, J.E. García-Sánchez, E. Letang, E. López-Suñé, F. Marco.
Guía de terapeútica antimicrobiana.
27th ed, Antares, (2018), pp. 294
[7]
G. Funke, R.A. Hutson, K.A. Bernard, G.E. Pfyffer, G. Wauters, M.D. Collins.
Isolation of Arthrobacter spp. from clinical specimens and description of Arthrobacter cumminsii sp. Nov. and Arthrobacter woluwensis sp.
Nov J Clin Microbiol, 34 (1996), pp. 2356-2363
Copyright © 2019. Elsevier España, S.L.U. and Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica
Opciones de artículo
Herramientas
es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos