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Case Reports
Bacteremia caused by Leuconostoc species : 6-case series
Ki Jong Oh1, Dong Sik Jung1, Kwan Soo Ko2, Ho Jin Lee1, Jun Yong Park1, Hyuck Lee1
Kosin Medical Journal 2018;33(3):422-430.
DOI: https://doi.org/10.7180/kmj.2018.33.3.422
Published online: January 19, 2018

1Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea

2Department of Molecular Cell Biology, Sungkyunkwan University College of Medicine, Suwon, Korea

Corresponding Author: Dong Sik Jung, Department of Internal Medicine, Dong-A University Hospital, 26, Daesingongwon-ro, Seo-gu, Busan 49201, Korea Tel: +82-51-240-2622 Fax: +82-51-4240-2622 E-mail: dongsik72@hanmail.net
• Received: July 29, 2016   • Accepted: October 19, 2016

Copyright © 2018 Kosin University School of Medicine Proceedings

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Leuconostoc species are Gram-positive coccobacilli and are used in dairy products and are intrinsically resistant to vancomycin. Leuconostoc infections are rare in humans, usually occurring in immune-compromised patients. We describe 6 patients with Leuconostoc bacteremia at Dong-A university hospital between 1990 and 2015. One isolate (L. lactis) was identified to species level using 16S rRNA gene sequencing analysis. All patients had underlying diseases and 5 patients underwent procedures that interrupted the normal integumentary defense. Four patients died within 30 days after being identified as carrying Leuconostoc species.
  • Keywords: Bacteremia; Leuconostoc; Vancomycin resistance
Fig. 1.
The phylogenetic relationships of isolate DAU-03 with other related Leuconostoc strains based on 16S rRNA gene sequences
kmj-33-422f1.jpg
Table 1.
Clinical feature of 6 patients with L. species bacteremia
Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6
Organism L. lactis L. pseudomes-enteroides L. pseudomes-enteroides L. mesenteroides L. citreum L. citreum
Age/ Sex 75/M 56/M 80F 65M 73F 60M
Underlying disease
Malignancies Pancreas cancer External auricular cancer Early gastric cancer Cholangio-carcinoma, Adavanced gastric cancer
Diabetes + + + - - -
Others Indwelling venous catheter C Cholecystitis Central catheter Chronic hepatitis BVenous port Congestive heart failure Atrial fibrillation Venous port Congestive heart failure Central catheter Venous port
*WBC(/mm3) 10,290 11,600 11,780 4,250 10,690 16,380
*CRP(mg/dL) 31.06 17.16 7.21 5.12 9.86 20.66
†Antibiotics Imipenem Ticarcillin /clavulanate Levofloxacin Cefepime Ceftriaxone Teicoplanin, Meropenem
‡All-cause mortality Died Died Survived Survived Died Died

* Reference range: WBC 3,000–10,000(/mm3), CRP 0–0.5(mg/dL)

† Adminitrated after Leuconostoc species identification

‡ All cause mortality in 30 days

Table 2.
Antimicrobial susceptibility of isolates of L. isolates
Patient 1 L. lactis Patient 2 L. pseudomes-enteroides Patient 3 L. pseudomes-enteroides Patient 4 L. mesenteroides Patient 5 L. citreum Patient 6 L. citreum
Ampicillin I (4)* S (< = 0.25) I (0.5) I (2) S (< = 2) I (4)
Imipenem S (< = 1)
Ciprofloxacin S (1)
Penicillin G I (0.5) I (0.25) I (0.25) I (1) S (1) I (2)
Vancomycin R (> = 8) R (> = 8) R (> = 8) R (>=8) R (> = 32) R (> = 8)
Clindamycin I (0.5) S (< = 0.25) S (< = 0.25) S (<=0.25) S (< = 0.25) S (< = 0.25)
Erythromycin S (< = 0.12) S (< = 0.12) S (< = 0.12) S (<=0.12) S (< = 0.25) S (< = 0.12)
Tetracyclin S (2) S (2) S (2) S (2) S (4) S (0.5)
Levofloxacin S (1) I (4) S (1) I (4) I (4) S (2)
Teicoplanin R (> = 32)
Norfloxacin R (> = 16)
Gentamicin S (†SYN-S)
Cefazolin S (2)
Ceftriaxone R (> = 8) R (> = 8) R (> = 8) R (> = 8) R (> = 8)
Cefotaxime R (4) R (4) R (> = 8) R (> = 8) R (> = 8)
Linezolid S (< = 2) S (< = 2) S (< = 2) S (< = 2) S (< = 2)

* Minimal inhibitory concentration (MIC)

† SYN: Synergistic

  • 1.Templin KS, Crook T, Riley T 3rd, Whitener C, Aber RC. Spontaneous bacterial peritonitis and bacteremia due to Leuconostoc species in a patient with end-stage liver disease; a case report. J Infect 2001;43:155–7.ArticlePubMed
  • 2.Handwerger S, Horowitz H, Coburn K, Kolokathis A, Wormser G. Infection due to Leuconostoc species: six cases and review. Rev Infect Dis 1990;12:602–10.ArticlePubMed
  • 3.Kim GY, Kim MH, Park SY, Park MJ, Suh JT, Lee HJ. A case of bacteremia caused by Leuconostoc lactis identified by 16S rRNA sequencing. Korean J Clin Microbiol 2006;9:137–41.
  • 4.Shin J, Her M, Moon C, Kim D, Lee S, Jung S. Leuconostoc bacteremia in a patient with amyloidosis secondary to rheumatoid arthritis and tuberculosis arthritis. Mod Rheumatol 2011;21:691–5.ArticlePubMed
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      Bacteremia caused by Leuconostoc species : 6-case series
      Kosin Med J. 2018;33(3):422-430.   Published online January 19, 2018
      DOI: https://doi.org/10.7180/kmj.2018.33.3.422
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    Bacteremia caused by Leuconostoc species : 6-case series
    Image
    Fig. 1. The phylogenetic relationships of isolate DAU-03 with other related Leuconostoc strains based on 16S rRNA gene sequences

    Fig. 1.

    Bacteremia caused by Leuconostoc species : 6-case series

    Clinical feature of 6 patients with L. species bacteremia

    Patient 1 Patient 2 Patient 3 Patient 4 Patient 5 Patient 6
    Organism L. lactis L. pseudomes-enteroides L. pseudomes-enteroides L. mesenteroides L. citreum L. citreum
    Age/ Sex 75/M 56/M 80F 65M 73F 60M
    Underlying disease
    Malignancies Pancreas cancer External auricular cancer Early gastric cancer Cholangio-carcinoma, Adavanced gastric cancer
    Diabetes + + + - - -
    Others Indwelling venous catheter C Cholecystitis Central catheter Chronic hepatitis BVenous port Congestive heart failure Atrial fibrillation Venous port Congestive heart failure Central catheter Venous port
    *WBC(/mm3) 10,290 11,600 11,780 4,250 10,690 16,380
    *CRP(mg/dL) 31.06 17.16 7.21 5.12 9.86 20.66
    †Antibiotics Imipenem Ticarcillin /clavulanate Levofloxacin Cefepime Ceftriaxone Teicoplanin, Meropenem
    ‡All-cause mortality Died Died Survived Survived Died Died

    Antimicrobial susceptibility of isolates of L. isolates

    Patient 1 L. lactis Patient 2 L. pseudomes-enteroides Patient 3 L. pseudomes-enteroides Patient 4 L. mesenteroides Patient 5 L. citreum Patient 6 L. citreum
    Ampicillin I (4)* S (< = 0.25) I (0.5) I (2) S (< = 2) I (4)
    Imipenem S (< = 1)
    Ciprofloxacin S (1)
    Penicillin G I (0.5) I (0.25) I (0.25) I (1) S (1) I (2)
    Vancomycin R (> = 8) R (> = 8) R (> = 8) R (>=8) R (> = 32) R (> = 8)
    Clindamycin I (0.5) S (< = 0.25) S (< = 0.25) S (<=0.25) S (< = 0.25) S (< = 0.25)
    Erythromycin S (< = 0.12) S (< = 0.12) S (< = 0.12) S (<=0.12) S (< = 0.25) S (< = 0.12)
    Tetracyclin S (2) S (2) S (2) S (2) S (4) S (0.5)
    Levofloxacin S (1) I (4) S (1) I (4) I (4) S (2)
    Teicoplanin R (> = 32)
    Norfloxacin R (> = 16)
    Gentamicin S (†SYN-S)
    Cefazolin S (2)
    Ceftriaxone R (> = 8) R (> = 8) R (> = 8) R (> = 8) R (> = 8)
    Cefotaxime R (4) R (4) R (> = 8) R (> = 8) R (> = 8)
    Linezolid S (< = 2) S (< = 2) S (< = 2) S (< = 2) S (< = 2)
    Table 1. Clinical feature of 6 patients with L. species bacteremia

    Reference range: WBC 3,000–10,000(/mm3), CRP 0–0.5(mg/dL)

    Adminitrated after Leuconostoc species identification

    All cause mortality in 30 days

    Table 2. Antimicrobial susceptibility of isolates of L. isolates

    Minimal inhibitory concentration (MIC)

    SYN: Synergistic

    Table 1.

    Table 2.

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