Infect Chemother.  2018 Jun;50(2):144-148. 10.3947/ic.2018.50.2.144.

A Case of Community-acquired Bacteremic Empyema Caused by Kocuria kristinae

• Kim KY
• Cho JH
• Yu CM
• Lee KJ
• Lee JM
• Koh S
• Kwon M
• Jeong D

• KMID: 2415036
• DOI: http://doi.org/10.3947/ic.2018.50.2.144

Abstract

Kocuria kristinae, part of the normal flora of the skin and oral mucosa, is seldom reported as a human pathogen; infection is mostly associated with immunocompromised patients in healthcare facilities. Here, we describe the first case of bacteremic empyema caused by K. kristinae acquired from the community. K. kristinae was isolated from pleural effusion and two sets of peripheral blood samples drawn from two different sites. The empyema resolved after the insertion of a chest tube and intravenous administration of piperacillin-tazobactam and levofloxacin.

Keyword

Kocuria kristinae; Infection; Bacteremia; Empyema; Community-acquired Infections

MeSH Terms

Administration, Intravenous
Bacteremia
Chest Tubes
Community-Acquired Infections
Delivery of Health Care
Empyema*
Humans
Immunocompromised Host
Levofloxacin
Mouth Mucosa
Pleural Effusion
Skin

Figure

• 

  Figure 1 Chest radiograph on hospital day 1 showing left hydropneumothorax and pleural adhesion.

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  Figure 2 (A) Low-dose chest CT image on hospital day 1 showing a large amount of left hydropneumothorax, multiloculated left pleural effusion, pleural adhesion in left thorax, and passive atelectasis of the left lung. (B) Enhanced chest CT image on hospital day 1 showing a large amount of multiloculated left pleural effusion with pleural enhancement and left pneumothorax, with passive atelectasis with bronchial mucus plugging in the left lung.

• 

  Figure 3 Enhanced chest CT image on hospital day 1 showing effusion near the mediastinum. Nearby esophagus(A) and pericardium (B).

Reference

1. Stackebrandt E, Koch C, Gvozdiak O, Schumann P. Taxonomic dissection of the genus Micrococcus: Kocuria gen. nov., Nesterenkonia gen. nov., Kytococcus gen. nov., Dermacoccus gen. nov., and Micrococcus Cohn 1872 gen. emend. Int J Syst Bacteriol. 1995; 45:682–692.

2. Basaglia G, Carretto E, Barbarini D, Moras L, Scalone S, Marone P, De Paoli P. Catheter-related bacteremia due to Kocuria kristinae in a patient with ovarian cancer. J Clin Microbiol. 2002; 40:311–313.

3. Carlini A, Mattei R, Lucarotti I, Bartelloni A, Rosati A. Kocuria kristinae: an unusual cause of acute peritoneal dialysis-related infection. Perit Dial Int. 2011; 31:105–107.

4. Cheung CY, Cheng NH, Chau KF, Li CS. An unusual organism for CAPD-related peritonitis: Kocuria kristinae . Perit Dial Int. 2011; 31:107–108.

5. Lai CC, Wang JY, Lin SH, Tan CK, Wang CY, Liao CH, Chou CH, Huang YT, Lin HI, Hsueh PR. Catheter-related bacteraemia and infective endocarditis caused by Kocuria species. Clin Microbiol Infect. 2011; 17:190–192.

6. Karadag Oncel E, Boyraz MS, Kara A. Black tongue associated with Kocuria (Micrococcus) kristinae bacteremia in a 4-month-old infant. Eur J Pediatr. 2012; 171:593.

7. Citro R, Prota C, Greco L, Mirra M, Masullo A, Silverio A, Bossone E, Piscione F. Kocuria kristinae endocarditis related to diabetic foot infection. J Med Microbiol. 2013; 62:932–934.

8. Tewari R, Dudeja M, Das AK, Nandy S. Kocuria kristinae in catheter associated urinary tract infection: a case report. J Clin Diagn Res. 2013; 7:1692–1693.

9. Ahmed NH, Biswal I, Roy P, Grover RK. Kocuria kristinae, an unusual pathogen causing opportunistic infections in patients with malignancy. Indian J Med Microbiol. 2014; 32:456–458.

10. Chen HM, Chi H, Chiu NC, Huang FY. Kocuria kristinae: a true pathogen in pediatric patients. J Microbiol Immunol Infect. 2015; 48:80–84.

11. Dunn R, Bares S, David MZ. Central venous catheter-related bacteremia caused by Kocuria kristinae: case report and review of the literature. Ann Clin Microbiol Antimicrob. 2011; 10:31.

12. Szczerba I. [Occurrence and number of bacteria from the Micrococcus, Kocuria, Nesterenkonia, Kytococcus and Dermacoccus genera on skin and mucous membranes in humans]. Med Dosw Mikrobiol. 2003; 55:67–74.

13. Ma ES, Wong CL, Lai KT, Chan EC, Yam WC, Chan AC. Kocuria kristinae infection associated with acute cholecystitis. BMC Infect Dis. 2005; 5:60.

14. Ben-Ami R, Navon-Venezia S, Schwartz D, Schlezinger Y, Mekuzas Y, Carmeli Y. Erroneous reporting of coagulase-negative Staphylococci as Kocuria spp. by the Vitek 2 system. J Clin Microbiol. 2005; 43:1448–1450.

15. Savini V, Catavitello C, Masciarelli G, Astolfi D, Balbinot A, Bianco A, Febbo F, D'Amario C, D'Antonio D. Drug sensitivity and clinical impact of members of the genus Kocuria. J Med Microbiol. 2010; 59:1395–1402.

16. Boudewijns M, Vandeven J, Verhaegen J, Ben-Ami R, Carmeli Y. Vitek 2 automated identification system and Kocuria kristinae . J Clin Microbiol. 2005; 43:5832.