Journal Article

<i>Lactobacillus</i> Bacteremia, Species Identification, and Antimicrobial Susceptibility of 85 Blood Isolates

M. K. Salminen, H. Rautelin, S. Tynkkynen, T. Poussa, M. Saxelin, V. Valtonen and A. Järvinen

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 42, issue 5, pages e35-e44
Published in print March 2006 | ISSN: 1058-4838
Published online March 2006 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/500214
Lactobacillus Bacteremia, Species Identification, and Antimicrobial Susceptibility of 85 Blood Isolates

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Background. Data regarding antimicrobial susceptibility of clinical Lactobacillus isolates are scarce, and appropriate interpretation criteria for susceptibility tests are not available.

Methods. We examined 85 cases of Lactobacillus bacteremia, of which 47 cases have been included in our previous studies. Overall, 14 antimicrobial agents were evaluated by the E-test method, and these results were compared with disk diffusion test findings. The clinical outcomes of the patients and their antimicrobial treatments were registered.

Results. The antimicrobial susceptibility of Lactobacillus strains was species dependent. The considerable number of Lactobacillus rhamnosus (n = 46), Lactobacillus fermentum (n = 12), and Lactobacillus casei (n = 12) strains available for testing made it possible to compare the susceptibilities within 1 species, as well. Of the 46 L. rhamnosus isolates, 22 were identified as L. rhamnosus GG type by pulsed-field gel electrophoresis. All Lactobacillus isolates demonstrated low minimum inhibitory concentrations (MICs) of imipenem, piperacillin-tazobactam, erythromycin, and clindamycin. MICs of vancomycin were high (>256 µg/mL) for all other species except Lactobacillus gasseri and Lactobacillus jensenii. Disk diffusion and E-test results were concordant. The MICs of cephalosporins varied; cefuroxime demonstrated a higher level of activity than did ceftriaxone. Benzylpenicillin and ampicillin MICs had variable ranges between different species. Combination therapy was given to 83% of the patients, but, in 54% of them, therapy included only 1 microbiologically active agent, according to results of the susceptibility tests. Mortality at 1 week was 12% among patients who presumably were receiving adequate treatment and 27% among patients who were receiving inadequate treatment (P = .131, by E-test).

Conclusion. Most clinical Lactobacillus blood isolates demonstrated low MICs of imipenem, piperacillin-tazobactam, erythromycin, and clindamycin, but they had variable susceptibility to penicillin and cephalosporins.

Journal Article.  3416 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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