Clinical Microbiology and Infection 25 (2019) 1054e1055

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Clinical Microbiology and Infection

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Letter to the Editor

Dermacoccus nishinomiyaensis as a cause of persistent paediatric

catheter-related bacteraemia
o 1, 2, A. Le Fle
C. Joron 1, B. Rome os 3, C. Rames 2, Y. El Samad 4, F. Hamdad 5, *
che-Mate
1)
Service des Urgences P ediatriques, CHU Amiens-Picardie, France
2)
Service de Cardio-Pneumologie P ediatrique, CHU Amiens-Picardie, France
3)
Institut Pasteur de Paris, Unit
e Environnement et Risques Infectieux, Cellule d’Intervention Biologique d’Urgence, France
4)
Service de Pathologies Infectieuses, CHU Amiens-Picardie, France
5)
Service de Bacteriologie, Centre de Biologie Humaine, CHU Amiens-Picardie, France

a r t i c l e i n f o

Article history: drawn, and a single blood BC culture yielded D. nishinomiyaensis

Received 19 January 2019 which was considered to be a contaminant.
Received in revised form Two months later the child was again admitted for another
15 February 2019 episode of fever. Two sets of catheter and peripheral venous blood
Accepted 20 February 2019
Available online 27 February 2019
cultures were drawn, and yielded D. nishinomiyaensis which was
then considered to be a pathogen. Fever promptly resolved after
Editor: L Leibovici initiation of vancomycin (60 mg/kg body weight daily) for 12 days.
One month later the child was admitted for fever (39.4
C) with
laboratory signs of inflammation. Five of seven catheter and pe-
ripheral venous blood cultures yielded D. nishinomiyaensis. Van-
comycin was reintroduced and urokinase lock therapy was instilled
Skin commensals are the most frequently reported causes of
into the BC and helped to maintain the catheter.
indwelling central venous catheter (CVC) infection due to colo-
Blood samples were cultured using the Peds Plus vials (Becton
nization of the catheter by the patient's own skin flora [1].
Dickinson), and culture was positive after 48 h incubation under
Micrococcal species (Kocuria, Nesterenkonia, Kytococcus, Der-
aerobic conditions. Gram staining revealed gram-positive cocci
macoccus, and Micrococcus) are most commonly found on the
occurring in pairs and tetrads. Bacterial growth occurred on sheep-
exposed skin of the face, hands and legs, and are usually not
blood Columbia agar at 35e37
C under aerobic conditions.
considered to be pathogens. Kocuria, Kytococcus, and Micro-
The identification was performed by matrix-assisted laser
coccus species have been implicated in catheter-related bacter-
desorption-ionization time-of-light mass spectrometry (MALDI-
aemia [2]. However, Dermacoccus is not usually considered to be a
TOF MS; Bruker Daltonics), and confirmed by sequencing a 1.5-kb
human pathogen.
fragment of the gene encoding the 16S RNA obtained by PCR
Our patient was a 1-year-old boy with colonic Hirschsprung's
using universal primers. The 1474-bp sequence of the isolate
disease. On the first day of life, emergency surgery was performed
was determined and compared to all bacterial sequences available
for small bowel obstruction due to atresia, and 41 cm of bowel were
in the GenBank database using the BLAST program (http://blast.
removed, followed by terminal ileostomy and colostomy. A sub-
ncbi.nlm.nih.gov/Blast.cgi), and showed 99% similarity to the
clavian CVC was inserted for home parenteral nutrition. The cath-
sequence of the D. nishinomiyaensis type strain (GenBank accession
eter rapidly became infected, and several septic episodes were
no.T.15_0004).
caused by Staphylococcus epidermidis, Lactobacillus fermentum,
Susceptibility testing was performed by disk diffusion on
Klebsiella pneumoniae, and Pseudomonas aeruginosa. The CVC was
MuellereHinton sheep-blood agar, and interpretation was based on
removed at each septic episode, and an implantable Broviac cath-
CA-SFM and EUCAST standard guidelines for Staphylococcus spe-
eter (BC; Hickman, Broviac, Grohong) was then inserted.
cies. The organism was resistant to fosfomycin but was susceptible
Five months later the child was admitted to hospital with fever
to all other antibiotics tested.
(39
C) but no laboratory signs of inflammation or catheter site
Clinical genotyping of the six isolates obtained over a 3-month
infection. Two sets of BCs and peripheral venous blood cultures were
period was performed by using the enterobacterial repetitive
intergenic consensus sequence PCR (ERIC-PCR) using the primer
* Corresponding author. F. Hamdad, Laboratoire de Bacte riologie, CBH, CHU 50 -AAGTAAGTGACTGGGGTGAGCG-30 . An identical PCR pattern was
 Laennec, 80054 Amiens Cedex 01, France.
Amiens-Picardie, Avenue Renne shown, suggesting a clonal D. nishinomiyaensis strain (Fig. 1).
E-mail address: Hamdad.Farida@chu-amiens.fr (F. Hamdad).

https://doi.org/10.1016/j.cmi.2019.02.023
1198-743X/© 2019 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.
 Letter to the Editor / Clinical Microbiology and Infection 25 (2019) 1054e1055
Fig. 1. Agarose gel electrophoresis of amplified DNA from clinical isolates obtained by
the ERIC-PCR method. Lanes 1, 8: Molecular weight standards; lanes 2-7: D. nishino-
miyaensis clinical strains.
The presence of an intravascular device is the most powerful risk
factor for bloodstream infections. In the present case the device
provided a niche for the Dermacoccus strain.
The rapid formation of a biofilm matrix prevents an adequate
immune response against the adhering bacteria. The biofilm also
impedes eradication of the microorganisms, despite treatment
with antimicrobial agents [1]. Vancomycin therapy allowed steril-
ization of blood cultures, and urokinase lock of the catheter allowed
a significantly higher success rate compared to systemic vanco-
mycin alone for the treatment of catheter-related sepsis [3], as
urokinase disrupts the integrity of the biofilm. The organism was no
longer detected after urokinase lock therapy.
We reviewed the literature on D. nishinomiyaensis as a signifi-
cant human pathogen. The Google search revealed one case related
to post-hysterectomy wound infection in a 28-year-old woman
with diabetes mellitus [4], while no cases of human
D. nishinomiyaensis infection were found in Medline Search.
1055
However, Dermacoccus barathri was recently described as the cause
of a human catheter-related bacteraemia in 7-year-old boy
receiving total parenteral nutrition for chronic intestinal pseudo-
obstruction [5]. Our report emphasizes that Dermacoccus should
be considered as a pathogen that can be responsible for catheter-
related infections that can be resolved by vancomycin and uroki-
nase lock therapy.
Transparency declaration
We declare no competing interests. No external funding was
received. Written informed consent for publication of this case
report was obtained from the child's father.
Contributors
CJ, BR, CR, YES conducted clinical examination and treatment of
the patient. FH performed bacteriological diagnosis. AL carried out
further investigations of these strains. FH wrote the manuscript. All
authors read and approved the final manuscript.
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