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Microbacterium paraoxydans is a rare cause of bacteraemia. We describe a case requiring line removal to affect a cure. We highlight the role of coryneform bacteria in patients with prosthetic devices and raise awareness of limitations in commonly used identification and susceptibility methods for these organisms.
A 15-year-old girl presented with a 4-week history of lethargy and generalised aches and pains. She had undergone a Nissen's fundoplication 4 weeks before her symptoms developed. Her medical history included congenital gut enteropathy (of unknown origin) with severe intestinal failure, and she has been dependent on total parenteral nutrition 5 nights a week (via a Hickman line) since the age of 3 months. She also had an IgG4 subclass deficiency, gastro-oesophageal reflux and left internal jugular vein thrombosis, for which she was anticoagulated with warfarin. A laparoscopic cholecystectomy had been performed 5 years previously and there were 13 subsequent Hickman line-associated bacteraemic episodes due to coagulase-negative staphylococci. No obvious reason for this high number of bacteraemic episodes was identified, and the current line had been in situ for ∼2 years without signs of infection at the insertion site. Examination was unremarkable except for a low-grade fever (37.5°C). Inflammatory markers were normal (white cell count 5.5×109/l (normal range (4–11)×109/l); C-reactive protein <10 mg/l).
Blood cultures (BacT/ALERT …
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.