Erysipelothrix rhusiopathiae is a gram-positive bacillus found mostly in pigs, fish, and sheep, most often causing zoonotic cutaneous infections in butchers, fish handlers, and veterinarians called erysipeloid. E. rhusiopathiae rarely causes invasive infection, but when bloodstream infections (BSI) occur, can be associated with infective endocarditis (IE). Few cases of E. rhusiopathiae BSI without IE have been described. We aimed to assess clinical outcomes of E. rhusiopathiae BSI and association with IE.
Our single-center, retrospective cohort study was conducted between 1/1/1994 to 4/15/2016 at our institution, which is a tertiary (referral) medical center. We utilized a web-based clinical data repository to search for patients whose medical records included E. rhusiopathiae. We manually reviewed medical records to access microbiology reports to confirm cases of E. rhusiopathiae BSI. Once these cases were identified, we collected data on patient demographics, risk factors, E. rhusiopathiae BSI, antimicrobial susceptibilities, incidence of IE, comorbidities, intensive care unit (ICU) admission, and duration of antimicrobial therapy.
Seventy potential cases were included by keyword search for E. rhusiopathiae. Only four true cases of laboratory-confirmed E. rhusiopathiae BSI were identified during the study period, which was confirmed with the microbiology lab review of blood culture isolates during that period. Risk factors included animal exposures, immunosuppression, diabetes, and kidney disease. All cases involved penicillin-sensitive strains and high-grade BSI. Three of the four cases demonstrated no IE on transesophageal echocardiogram. All patients recovered fully with intravenous antibiotics.
E. rhusiopathiae can cause BSI in the absence of IE. The previously reported 90% association between BSI and IE may be overestimated due to reporting bias. E. rhusiopathiae should be suspected in any patient with gram-positive bacilli in blood cultures and the aforementioned risk factors.
J. R. Marcelin,
N. Adeel, None
R. Lewis, None
M. Enzler, None
P. K. Tosh, None
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