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Abstract
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.
Highlights
Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry (MS)) allows us to identify bacteria directly from positive blood cultures with detailed taxonomy naming of the bacterial strains
Since the original description of Trueperella bernardiae in 1987 as a coryneform group 2 bacterium by the Centers for Disease Control and Prevention (Na’was et al, 1987), a total of 15 human pathogen strains have been reported in the literature
We found that T. bernardiae grew on 5 % blood agar incubated aerobically in 5 % CO2 and anaerobically, as well as on chocolate agar with or without vitamin K and cysteine
Summary
Since the original description of Trueperella bernardiae in 1987 as a coryneform group 2 bacterium by the Centers for Disease Control and Prevention (Na’was et al, 1987), a total of 15 human pathogen strains have been reported in the literature. After 48 h of incubation on 5 % blood agar plates in ambient air, the pus specimen yielded growth of Staphylococcus simulans (which was considered a contaminant) and T. bernardiae Blood cultures (growth in one of two anaerobic bottles and no growth in the two corresponding aerobic bottles at 35 uC in the BacT/ALERT 3D system; BioMerieux) were positive after 48 h, and the Gram-stained slides showed small Grampositive coccoid bacilli After another 48 h of incubation on 5 % blood agar plates in 5 % CO2, growth of two different types of unpigmented, pinpoint colonies was seen, which were identified as T. bernardiae and Peptostreptococcus sp. The growth of T. bernardiae was improved anaerobically Identification of both T. bernardiae and P. lacrimalis isolated from the blood culture was confirmed by Sanger sequencing of a PCR product targeting the rrs gene. The patient was followed in the outpatient clinic and no signs of reoccurrence have been observed for 3 months
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