KOCURIA SPECIES: EMERGING PATHOGENS IN CHILDREN WITH CENTRAL VENOUS CATHETER, A CASE REPORT AND REVIEW OF LITERATURE

Abstract

Kocuria species (KS) are gram-positive, coagulase-negative coccoids. Reports about KS infection in children are limited. We performed a short-review of literature and described a case of catheter related-bloodstream infection (CR-BSI) caused by KS. Electronic search through PubMed was conducted using the keywords: “Kocuria” AND “children” AND “sepsis”. The earliest publication date was of 2008, the latest of 2017 We analyzed 7 articles with 15 cases described. KS were responsible of endocarditis in 1 child, CR-BSI in 13 children and spontaneous bacterial peritonitis in 2 children. Most were immunocompromised hosts and CVC-carriers (2 short-bowel syndrome, 2 tumor, 1 congenital tufting-enteropathy, 1 Hirschsprung's disease, 1 methylmalonic-aciduria, 6 prematurity). Only 1 was an otherwise healthy child. Case report: during the COVID-19 lockdown, a 17yeas-old boy affected by Hirschsprung's disease and CVC-carrier developed fever, chills, vomit and hematuria. Due to “hospital fear”, he began empirical therapy with ceftriaxone at home, without symptoms resolution. Once admitted to the department, blood exams showed: normal lymphocyte immunophenotyping, thrombocytopenia, increased CRP and hyperbilirubinaemia. Haematuria, proteinuria and glycosuria also occurred. Culturing blood samples showed KS infection. Echocardiography was normal. Basing on the antibiogram, we started treatment with vancomycin with rapid patient recovery. The use of CVCs in immunocompromised patients represents the most important risk factor for KS-BSI. Due to the limited number of reports about this infection, there are no guidelines to manage it.In patients with a chronic disease, opportunistic pathogens as KS must be considered, also because symptoms and complications are still unknown.