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Sepsis following acute pyelonephritis caused by Trueperella bernardiae: a case report and literature review

Abstract

Background

Trueperella bernardiae is a coryneform, gram-positive bacterium that is a commensal of the skin and upper respiratory tract. It is treated as a contaminant and rarely causes infections. Blood, urine, and abscesses have been previously reported as the most common sites of infection. Infections caused by T. bernardiae are rarely reported in bedridden very old patients with reduced activities of daily living (ADL). In this report, we describe a case of sepsis due to acute pyelonephritis caused by T. bernardiae in a very old patient with impaired ADL.

Case presentation

A 94-year-old woman had a home visit from her local physician. She was bedridden and used diapers. On the day of admission, she presented with fever and dyspnea and was admitted with a diagnosis of sepsis associated with acute pyelonephritis. T. bernardiae was detected in blood and urine cultures; furthermore, multiple bacteria were detected in a urine culture. She was treated with ampicillin/sulbactam 3 g every 12 h on the day of admission. The fever was controlled, and inhaled oxygen 1 L/min via a nasal cannula was administered for dyspnea until hospitalization day 2. On hospitalization day 2, her fever resolved to 36 °C. Antimicrobials were de-escalated and changed to cephazolin and then to cephalexin on hospitalization days 9 and 16, respectively, and were continued until day 22. On hospitalization day 28, the urinary tract infection flared up; however, her fever resolved by hospitalization day 38 after the re-administration of antimicrobial agents. She was discharged on hospitalization day 60.

Conclusions

We encountered a rare case of sepsis following acute pyelonephritis caused by T. bernardiae infection. When bedridden, diaper-using, very old patients present with urinary tract infections caused by multiple bacteria, the presence of rare opportunistic organisms, such as T. bernardiae, should be considered.

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Background

Trueperella bernardiae is a coryneform, gram-positive coccobacillus [1, 2]. Until 1995, T. bernardiae, which is characterized by negative catalase production, belonged to Centers for Disease Control and Prevention coryneform group 2 [1]. It was assigned to the genus Actinomyces in 1995 [2], Arcanobacterium in 1997 [3], and transferred to the genus Trueperella in 2011 [4]. T. bernardiae is a commensal bacterium found on the skin and in the upper respiratory tract. It is usually treated as a contaminant and rarely as an infectious agent [1]. Although reports on T. bernardiae infection have been increasing [5,6,7], there have been few reports in bedridden old patients with impaired activities of daily living (ADL) [7, 8]. In this report, we describe a case of sepsis due to acute pyelonephritis caused by T. bernardiae in a very old patient with impaired ADL.

Case presentation

A 94-year-old woman was receiving home visits and treatment for comorbidities including hypertension, chronic heart failure, dementia, chronic kidney disease, osteoporosis, and constipation. She sustained a left femoral transverse fracture 4 years and 2 months before her presentation and has been bedridden since then. She was attended to at home by a house call physician because of dyspnea on the day of admission and was then rushed to our hospital because of fever (40 °C) with chills. According to her medical history, she had suffered a spinal compression fracture at the age of 84 years and a left femoral transverse fracture at the age of 90 years, for which she underwent artificial head replacement surgery. She was bedridden and used diapers for excretion.

The vital signs at the time of our visit were as follows: level of consciousness, Glasgow Coma Scale (GCS) score, 11 points (E3V2M6); body temperature, 40 °C; blood pressure, 97/56 mmHg; heart rate, 110 beats/min; respiratory rate, 30 breaths/min; and SpO2, 96% (O2 mask 6 L/min). Pupils were of the same size, normal contralateral light reflex was noted, and there was no pharyngeal redness; no tonsillar redness, swelling, or moss white color. The heart and respiratory sounds were normal. There was no skin rash or abnormal findings, such as tenderness, heat, or swelling of the joints. She tended to be somnolent and had no clear costovertebral angle tenderness.

Laboratory data at the time of her visit are presented in Table 1. The white blood cell (WBC) count was 17,400/μL and the C-reactive protein (CRP) level was 12.31 mg/dL. Urinalysis showed a leukocyte count of > 100/high power field, gram-positive cocci (3+), gram-positive rods (1+), and gram-negative rods (3+) on urine Gram staining. The Quick Sequential Organ Failure Assessment (qSOFA) score was 3 points [9, 10] and the SOFA score was 3 points [10,11,12]. Abdominal computed tomography showed stones in both kidneys, right ureteral dilation, and a thickened bladder wall (Fig. 1).

Table 1 Patient’s laboratory data on admission
Fig. 1
figure 1

Abdominal computed tomography at admission. There are stones in both kidneys, right ureteral dilation (a), and a thickened bladder wall (b)

She was diagnosed as having sepsis associated with acute pyelonephritis. Gram-positive cocci were detected in the urine, and penicillin antimicrobials were selected to cover enterococci. Intravenous ampicillin/sulbactam administration of 3 g every 12 h was initiated on the day of admission. The fever was controlled, and inhaled oxygen 1 L/min using a nasal cannula was administered for dyspnea until hospitalization day 2. The temperature temporarily dropped to the 37 °C range but rose again to 40 °C, followed by remittent fever. The temperature resolved to 36 °C on hospitalization day 2. The level of consciousness also improved to a GCS score of 15 points (E4V5M6). The number of viable bacteria in a urine culture was 106 CFU/mL, and Pseudomonas sp. (3+), Streptococcus sp. (3+) and Corynebacterium sp. (1+) were detected. Since ampicillin/sulbactam was effective, Pseudomonas sp. was considered not to be the initiating bacterium. On hospitalization day 9, based on the antimicrobial susceptibility of other bacteria, the patient was started receiving cefazolin 1 g intravenous infusion every 12 h. On hospitalization day 10, gram-positive coccobacilli, identified as Arcanobacterium sp, were detected in two sets of blood cultures. The samples were analyzed using a Matrix Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometer (MALDI-TOF MS) and were identified as T. bernardiae (identification score > 2.0). Similarly, T. bernardiae was detected in a urine culture by MALDI-TOS MS analysis. 16SrRNA gene sequencing was not performed.

As no T. bernardiae breakpoints are specified by the Clinical and Laboratory Standards Institute (CLSI) or The European Committee on Antimicrobial Susceptibility Testing (EUCAST), susceptibility testing was performed based on the CLSI criteria for Corynebacterium sp., and the susceptibility was determined based on the size of the inhibition circle [13]. Susceptible and resistant bacteria were determined based on whether the inhibition circle was > 30 mm using the disk method. Antimicrobial agents were also selected based on this method. The results are presented in Table 2. The bacteria were susceptible to penicillin G, amoxicillin, piperacillin, cefazolin, cefotiam, ceftriaxone, cefozopran, meropenem, imipenem/cilastatin, amoxicillin/clavulanic acid, piperacillin/tazobactam, amikacin, erythromycin, clarithromycin, clindamycin, minomycin, fosfomycin, and vancomycin, but were resistant to levofloxacin and sulfamethoxazole/trimethoprim. Bacteria from urine and blood cultures were similarly susceptible. T. bernardiae was susceptible to cephazolin and, therefore, the antimicrobial therapy was continued.

Table 2 Results of drug sensitivity test for Trueperella bernardiae cultured

Two sets of blood samples cultured on hospitalization day 11 were negative. Since oral intake was improved, she was switched to oral cephalexin 1 g/day on hospitalization day 16. On hospitalization day 22, antimicrobial therapy was terminated (Fig. 2).

Fig. 2
figure 2

Clinical course after treatment initiation. ABPC/SBT: ampicillin/sulbactam; CEZ: cefazolin; CEX: cephalexin

Thereafter, rehabilitation is provided for declining ADLs and she was discharged on hospitalization day 60.

Discussion

We encountered a case of sepsis following acute pyelonephritis caused by T. bernardiae, a commensal bacterium found on the skin and in the upper respiratory tract. Although T. bernardiae is a rare cause of infection, it was detected in two sets of blood cultures and in a urine culture in the present case. Moreover, it was observed to be the causative agent of the infection, which was considered to have occurred because the patient was very old, bedridden with reduced ADL, and used diapers for defecation.

In this case, multiple bacteria were initially detected in a urine culture. As ampicillin/sulbactam was effective, Pseudomonas sp. was not considered for treatment. Other detected bacteria were sensitive to ampicillin/sulbactam and cefazolin. Finally, only T. bernardiae was detected in blood cultures and was determined to be the initiating bacterium for sepsis. It seems possible that the urinary tract was also infected with several other bacteria.

In general, we do not routinely keep images in our daily clinical practice. Unfortunately, the Gram staining and culture results in this case were not recorded because there is no laboratory in the hospital to obtain the information, and the results were outsourced to another laboratory outside of the hospital.

Regarding the antimicrobial susceptibility of T. bernardiae, resistance to penicillins [14, 15], aminoglycosides [14], macrolides [16,17,18,19], quinolones [19], sulfamethoxazole/trimethoprim [14, 18], and fosfomycin [8] have been reported. In this case, the patient was non-responsive to quinolones and sulfamethoxazole/trimethoprim. No cephalosporin-resistant bacteria have been reported.

As there are no reports of T. bernardiae resistance to β-lactamase-containing penicillin, carbapenems, and cephems (although resistance to penicillin has been reported), we suggest that before the results of susceptibility testing are known, antimicrobial therapy should include β-lactamase-containing penicillin, if the patient is in good general condition, and carbapenems, if the patient is in poor general condition.

As reports of infections caused by T. bernardiae are rare, a comprehensive literature review was conducted. Thirty articles were searched using the keywords "Trueperella bernardiae," "Arcanobacterium bernardiae," or "Actinomyces bernardiae" on PubMed database. The search identified 19 case reports (including 27 cases) since 1996 (Table 3). In addition, five case reports (including five cases) related to these articles were not archived in PubMed [5,6,7,8, 14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]. (Last PubMed search: November 28, 2022).

Table 3 Clinical features of cases of Trueperella bernardiae infection in the literature

The median age of the 32 patients (14 men and 18 women) was 62 years (range, 5–91 years), with no obvious age or sex disparity. T. bernardiae was often detected in the presence of other organisms, and the prognosis was good in many cases. Among the reported cases, nine, six, four, four, and two cases were of British, American, French, Spanish, and Japanese patients, respectively, while there was one case of Belgian, Chilean, Brazilian, Korean, Italian, Thai, and Danish patient each. The underlying diseases varied from diabetes mellitus to post-arthroplasty but were most frequently identified in patients with an immunocompromised status. The sites of infection included the urinary tract, blood, brain abscess, and breast abscess in five, 12, two, and two cases, respectively, and in other sites (including the skin, surgical sites, and joints). In the present case, the organism was detected in two sets of blood and urine cultures, suggesting that sepsis might have occurred, following the acute pyelonephritis caused by T. bernardiae.

The long-term decline in physical activity due to aging, loss of strength and motivation, and various diseases of the musculoskeletal and cardiovascular systems may lead to disuse syndrome [34, 35]. As disuse syndrome progresses, the patient develops secondary disabilities, such as muscle weakness, joint contractures, circulatory disorders, and psychiatric symptoms, such as depression and dementia. As a result, they become susceptible to infection. In addition, diaper users have a high incidence of chronic cystitis [36, 37]. In the present case, the patient was bedridden, very old, and her ADL had decreased, so she could have been easily infected. Since T. bernardiae is a commensal bacterium of the skin, it may have been transmitted via the diaper.

T. bernardiae is frequently reported in multiple bacterial infections. Therefore, when urinary tract infection occurs in the presence of several bacterial infections in old diaper-using patients with reduced ADL, such as in this case, it is necessary to note the presence of rare bacteria that can cause opportunistic infections.

Our study had some limitations. First, as this study is a case report, it is difficult to generalize the findings to other very old, diaper-using, bedridden patients with reduced ADL. In addition, the long-term health effects of T. bernardiae infection remain unknown. In the future, we hope to investigate the long-term health effects of T. bernardiae infection by conducting long-term observations of this patient population.

Conclusion

We report a rare case of sepsis following acute pyelonephritis caused by T. bernardiae. Very old patients with reduced ADL who are bedridden and use diapers are prone to infections and chronic cystitis. When such patients present with urinary tract infections with multiple bacterial infections, we should consider infections caused by rare bacteria or opportunistic infections.

Availability of data and materials

All data generated or analyzed during this study are included in this published article.

Abbreviations

ADL:

Activities of daily living

GCS:

Glasgow Coma Scale

WBC:

White blood cell

CRP:

C-reactive protein

SOFA:

Sequential Organ Failure Assessment

qSOFA:

Quick SOFA

MALDI-TOF MS:

Matrix Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometer

CLSI:

Clinical and Laboratory Standards Institute

EUCAST:

The European Committee on Antimicrobial Susceptibility Testing

S:

Susceptible

R:

Resistant

ABPC/SBT:

Ampicillin/sulbactam

CEZ:

Cefazolin

CEX:

Cephalexin

References

  1. Na’Was TE, Hollis DG, Moss CW, Weaver RE. Comparison of biochemical, morphologic, and chemical characteristics of centers for disease control fermentative coryneform groups 1, 2, and A-4. J Clin Microbiol. 1987;25:1354–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Funke GC, Ramos CP, Fernández-Garayzábal JF, Weiss N, Collins MD. Description of human-derived Centers for Disease Control coryneform group 2 bacteremia as Actinomyces bernardiae sp nov. Int J Syst Bacteriol. 1995;45:57–60.

    Article  CAS  PubMed  Google Scholar 

  3. Ramos CP, Foster G, Collins MD. Phylogenetic analysis of the genus Actinomyces based on 16 rRNA gene sequences: description of Arcanobacterium phocae sp. nov., Arcanobacterium bernardiae comb. Nob. and Arcanobacterium pyogenes comb. nov. Int J Syst Bacteriol. 1997;47:46–53.

    Article  CAS  PubMed  Google Scholar 

  4. Yassin AF, Hupger H, Siering C, Schumann P. Comparative chemotaxonomic and phylogenetic studies on the genus Arcanobacterium Collins et al. 1982 emend. Lehnen et al. 2006: proposal for Trueperella gen. nov. and emended description of the genus Arcanobacterium. Int J Syst Evol Microbiol. 2011;61:1265–74.

    Article  CAS  PubMed  Google Scholar 

  5. Tang W, Desai K. A case of prosthetic hip infection and abscess caused by Trueperella bernardiae. New Microbes New Infect. 2021;41: 100885.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Casale R, Bianco G, Cosma S, Micheletti L, Comini S, Iannaccone M, et al. Trueperella bernardiae bloodstream infection following onco-gynaecologic surgery and literature review. Infez Med. 2022;30:124–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  7. Seki M, Andow T, Imamura M, Takahashi Y, Azuma M, Watanabe N. A case of obstructive pyelonephritis caused by Trueperella bernardiae isolated from blood. Igaku kensa. 2022;71:538–43.

    Google Scholar 

  8. Otto MP, Foucher B, Lions C, Dardare E, Gérôme P. Trueperella bernardiae soft tissue infection and bacteremia. Med Mal Infect. 2013;43:487–9.

    Article  PubMed  Google Scholar 

  9. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:801–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Seymour CW, Liu VX, Iwashyna TJ, Brunkhorst FM, Rea TD, Scherag A, et al. Assessment of clinical criteria for sepsis: for the third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA. 2016;315:762–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intencive Care Med. 1996;22:707–10.

    Article  CAS  Google Scholar 

  12. Vincent JL, de Mendonça A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study Working group on "sepsis-related problems" of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26:1793–800.

    Article  CAS  PubMed  Google Scholar 

  13. Clinical and Laboratory Standards Institute (CLSI). Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria. 3rd ed, CLSI Guideline M45A2, 24–26. Wayne, PA, 2016.

  14. Loïez C, Tavani F, Wallet F, Flahaut B, Senneville E, Girard J, et al. An unusual case of prosthetic joint infection due to Arcanobacterium bernardiae. J Med Microbiol. 2009;58:842–3.

    Article  PubMed  Google Scholar 

  15. Roh J, Kim M, Kim D, Yong D, Lee K. First case of Trueperella bernardiae bacteremia in an immunocompromised patient in Korea. Ann Lab Med. 2019;39:593–5.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kawahara N, Irimura K, Koga T. A case of acute pyelonephritis with bacteremia caused by Trueperella bernardiae. Nippon Rinsho Biseibutsu Gakkai Zasshi. 2017;27:39–44.

    Google Scholar 

  17. Lawrence CHD, Waseem S, Newsholme W, Klein JL. Trueperella bernardiae: an unusual cause of septic thrombophlebitis in an injection drug user. New Microbes New Infect. 2018;26:89–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Calatrava E, Borrego J, Cobo F. Breast abscess due to Trueperella bernardiae and Actinotignum sanguinis. Rev Esp Quimioter. 2019;32:200–2.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Cobo F, Rodríguez-Granger J, Sampedro A, Gutiérrez-Fernández J, Navarro-Marí JM. Two rare cases of wound infections caused by Trueperella bernardiae. Jpn J Infect Dis. 2017;70:682–4.

    Article  PubMed  Google Scholar 

  20. Ieven M, Verhoeven J, Gentens P, Goossens H. Severe infection due to Actinomyces bernardiae: case report. Clin Infect Dis. 1996;22:157–8.

    Article  CAS  PubMed  Google Scholar 

  21. Lepargneur JP, Heller R, Soulié R, Riegel P. Urinary tract infection due to Arcanobacterium bernardiae in a patient with a urinary tract diversion. Eur J Clin Microbiol Infect Dis. 1998;17:399–401.

    CAS  PubMed  Google Scholar 

  22. Adderson EE, Croft A, Leonard R, Carroll K. Septic arthritis due to Arcanobacterium bernardiae in an immunocompromised patient. Clin Infect Dis. 1998;27:211–2.

    Article  CAS  PubMed  Google Scholar 

  23. Bemer P, Eveillard M, Touchais S, Redon H, Corvec S. A case of osteitis due to Staphylococcus aureus and Arcanobacterium bernardiae coinfection. Diagn Microbiol Infect Dis. 2009;63:327–9.

    Article  PubMed  Google Scholar 

  24. Clarke TM, Citron DM, Towfigh S. The conundrum of the gram-positive rod: are we missing important pathogens in complicated skin and soft-tissue infections? A case report and review of the literature. Surg Infect. 2010;11:65–72.

    Article  Google Scholar 

  25. Sirijatuphat R, Angkasekwinai N. Perinephric abscess and empyema thoracis due to Arcanobacterium bernardiae. J Infect Dis Antimicrob Agents. 2010;27:103–8.

    Google Scholar 

  26. Weitzel T, Braun S, Porte L. Arcanobacterium bernardiae bacteremia in a patient with deep soft tissue infection. Surg Infect. 2011;12:83–4.

    Article  Google Scholar 

  27. Parha E, Alalade A, David K, Kaddour H, Degun P, Namnyak S. Brain abscess due to Trueperella bernardiae. Br J Neurosurg. 2015;29:728–9.

    Article  PubMed  Google Scholar 

  28. Schneider UV, Ekenberg C, Sode N, Knudsen JD. A case of diabetic foot ulcers complicated by severe infection and sepsis with Trueperella bernardiae. JMM Case Rep. 2015;2: e000006.

    Article  Google Scholar 

  29. Rattes ALR, Araujo MR, Federico MP, Magnoni CD, Neto PA, Furtado GH. Trueperella bernardiae: first report of wound infection post laparoscopic surgery. Clin Case Rep. 2016;4:812–5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gilarranz R, Chamizo F, Horcajada I, Bordes-Benítez A. Prosthetic joint infection caused by Trueperella bernardiae. J Infect Chemother. 2016;22:642–4.

    Article  PubMed  Google Scholar 

  31. VanGorder BRF, Ahmed SS, Rawling RA, Granato PA. Trueperella bernardiae abscess infection: a case report. Clin Microbiol Newsl. 2016;38:100–1.

    Article  Google Scholar 

  32. Gowe I, Parsons C, Best M, Parsons E, Prechter S, Vickery S. Successful treatment of olecranon bursitis caused by Trueperella bernardiae: importance of environmental exposure and pathogen identification. Case Rep Infect Dis. 2018;2018:5353085.

    PubMed  PubMed Central  Google Scholar 

  33. Pan J, Ho AL, Pendharkar AV, Sussman ES, Casazza M, Cheshier SH, et al. Brain abscess caused by Trueperella bernardiae in a child. Surg Neurol Int. 2019;10:35.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Hirschverg GG, editors. Rehabilitation—a manual for the care of the disabled and elderly. Lippincott, Pennsylvania; 1964.

  35. Halar EM, et al. Physical medicine and rehabilitation principles and practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2005. p. 1447–67.

    Google Scholar 

  36. Silva JLAD, Fonseca CDD, Stumm EMF, Rocha RM, Silva MRD, Barbosa DA. Factors associated with urinary tract infection in a nursing home. Rev Bras Enferm. 2021;74: e20200813.

    Article  Google Scholar 

  37. Iwatsubo E. Diaper cystits as recurrent cause of urinary infections in geriatric community hospital. J Jpn Geriatic. 2021;49:114–8.

    Article  Google Scholar 

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YM managed the case and prepared and revised the manuscript. TK assisted with the preparation and revision of the manuscript. SK, JT, HH, and TG assisted with data analysis and revision of the manuscript. All co-authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. All co-authors take full responsibility for the integrity of the report and the final manuscript. All authors read and approved the final manuscript.

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Correspondence to Yuki Matsuhisa.

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Matsuhisa, Y., Kenzaka, T., Kobayashi, S. et al. Sepsis following acute pyelonephritis caused by Trueperella bernardiae: a case report and literature review. BMC Infect Dis 23, 121 (2023). https://doi.org/10.1186/s12879-023-08080-8

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