LETTERS

8. Wade AJ, Walker T, Athan E, Hughes AJ. agents including colistin sulfomethate, 20E, and VITEK 2 Auto system (bio- Spontaneous splenic rupture: a rare com- tobramycin sulfate, ceftazidime, and Mérieux, Marcy l’Etoile, France) did plication of in Australia. Med J Aust. 2006;184:364. linezolid was administered, starting not identify the bacillus. This bacteri- 9. Barrio J, de Diego A, Ripoll C, Perez- on posttransplant day 1; prophylactic um was multiresistant to antimicrobial Calle JL, Núñez O, Salcedo M, et al. caspofungin, followed by inhaled am- agents, including colistin, and was sus- Mediterranean spotted fever in liver trans- photericin B, was given for the fi rst ceptible only to imipenem, rifampin, plantation: a case report. Transplant Proc. 2002;34:1255–6. month. Six and 9 days, respectively, and aminoglycosides. The fi nal iden- 10. Rallis TM, Kriesel JD, Dumler JS, Wag- after surgery, sputa from the patient tifi cation of this isolate as Acetobacter oner LE, Wright ED, Spruance SL. showed P. aeruginosa and MRSA. indonesiensis was achieved after par- Rocky Mountain spotted fever follow- On postoperative day 11, the pa- tial sequencing of 16S rRNA gene, as ing cardiac transplantation. West J Med. 1993;158:625–8. tient’s clinical condition worsened. previously described (2) (GenBank Leukocytes increased to 13.84 × accession no. AJ199841, 99% similar- 9 Address for correspondence: Marc Lecuit, 10 /L. In addition to P. aeruginosa ity). The sequence of our isolate has 4 3 Service des Maladies Infectieuses et Tropicales, (10 CFU/mL) and MRSA (10 CFU/ been deposited in GenBank under the Centre d’Infectiologie Necker-Pasteur, Hôpital mL), culture of later sputum samples accession no. EF681860. The phylo- 4 Necker-Enfants Malades, 149 rue de Sèvres, yielded the growth of 10 CFU/mL genetic position of isolate 7120034 75015 Paris, France; email: [email protected] of gram-negative, catalase-positive, among other gram-negative is and oxidase-negative bacillus (isolate shown in the Figure. 7120034) on CEPACIA agar (AES, Tobramycin was stopped at day Combourg, France) after 72 hours of 11, colistin and ceftazidime were incubation at 30°C. API 20NE, API stopped at postoperative day 14, lin-

Acetobacter indonesiensis after Lung Transplant To the Editor: Unusual and multiresistant bacterial infections are increasingly reported in cystic fi bro- sis (CF) patients (1). On January 25, 2007, a 31-year-old man with CF (mu- tation ΔF 508 and I 507) was admitted to our institution in Marseille, France, for lung transplantation. His immuno- suppressive regimen included IV cy- closporin A (for the fi rst 6 days with conversion to oral tacrolimus thereaf- ter), azathioprine, and corticosteroids. Induction therapy that used antithy- mocyte globulin was administered for the fi rst 3 days (Thymoglobuline, Genzyme Corporation, Naarden, the Netherlands). Since 2003, the patient was chronically colonized by methi- cillin-resistant Staphylococcus aureus (MRSA), (susceptible only to colistin sulfo- Figure. Phylogenetic tree showing the position of Acetobacter indonesiensis (isolate methate), and Candida albicans. Pre- 7120034, GenBank accession no. EF681860), in boldface, within acetic acid bacteria and emptive treatment with antimicrobial other gram-negative rods. The tree was based on 16S rDNA comparison by the neighbor- joining method. Numbers along the branches indicate bootstrap values.

Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 6, June 2008 997 LETTERS ezolid was maintained for 10 addition- We also report the antimicrobial 2. Drancourt M, Bollet C, Raoult D. al days, and gentamicin (for 13 days) drug susceptibility of this bacterium. Stenotrophomonas africana sp. nov., an opportunistic human in Africa. was added to the patient’s drug thera- It was multiresistant, especially to Int J Syst Bacteriol. 1997;47:160–3. py on February 10. Despite this treat- colistin. Antimicrobial drug suscepti- 3. Cleenwerck I, Vandemeulebroecke K, ment, A. indonesiensis was cultured bility results were obtained by using Janssens D, Swings J. Re-examination of from sputa obtained on February 16 Vitek 2 Auto system because of the the genus Acetobacter, with descriptions 4 2 of Acetobacter cerevisiae sp. nov. and Ac- (10 CFU/mL) and February 20 (10 absence of growth on Mueller-Hinton etobacter malorum sp. nov. Int J Syst Evol CFU/mL), respectively. Six days later, agar. This pattern was also the case for Microbiol. 2002;52:1551–8. leukocytes decreased to 8.62 × 109/L, G. bethesdensis (6). The antimicro- 4. Yamada Y, Hosono R, Lisdyanti P, Widyas- and the patient’s condition improved. bial susceptibility of A. cibinongensis tuti Y, Saono S, Uchimura T, et al. Identifi - cation of acetic acid bacteria isolated from He was discharged at the beginning could not be validated because of the Indonesian sources, especially of isolates of March. During 7 months of follow- lack of interassay reproducibility (7). classifi ed in the genus Gluconobacter. J up, the A. indonesiensis strain was not Initial antimicrobial drug therapy for Gen Appl Microbiol. 1999;45:23–8. found again. this patient with amoxicillin, pristi- 5. Snyder RW, Ruhe J, Kobrin S, Wasser- stein A, Doline C, Nachamkin I, et al. Acetic acid bacteria are gram- namycin, and cefazolin did not cure bogorensis peritonitis identifi ed by negative bacilli classifi ed into the gen- the patient; he was eventually cured 16S ribosomal RNA sequence analysis in era Acetobacter, Gluconobacter, Glu- after the therapy was switched to to- a patient receiving peritoneal dialysis. Am conacetobacter, Acidomonas, and the bramycin (7). J Kidney Dis. 2004;44:e15–7. 6. Greenberg DE, Ding L, Zelazny AM, Stock recently described genus Asaia; these Our fi ndings reemphasize the F, Wong A, Anderson VL, et al. A novel bacteria belong to the α subgroup of emergence of new colistin-resistant bacterium associated with lymphadenitis (3). Isolates of this in CF patients, as recently in a patient with chronic granulomatous family are recognized as food-asso- reported for Inquilinus limosus (1). disease. PLoS Pathog. 2006;2:e28. 7. Gouby A, Teyssier C, Vecina F, Marchan- ciated bacteria and are able to grow The increased clinical use of nebu- din H, Granolleras C, Zorgniotti I, et al. at acidic pH (4). Three species have lized colistin for P. aeruginosa infec- Acetobacter cibinongensis bacteremia in been reported as emerging pathogens tion in CF patients may select specifi c human. Emerg Infect Dis. 2007;13:784–5. in humans: Asaia bogorensis (in a case colistin-resistant bacteria in such pop- 8. Lisdiyanti P, Kawasaki H, Seki T, Yamada Y, Uchimura T, Komagata K. Systematic of peritonitis in a patient with a peri- ulations. In summary, this report of a study of the genus Acetobacter with de- toneal dialysis catheter [5]); Granu- respiratory tract infection caused by scriptions of Acetobacter indonesiensis libacter bethesdensis (in 3 cases of A. indonesiensis after lung transplan- sp. nov., Acetobacter tropicalis sp. nov., lymphadenitis associated with chronic tation in a French CF patient supports Acetobacter orleanensis (Henneberg 1906) comb. nov., Acetobacter lovanien- granulomatous disease [6]); and Ac- that this multidrug-resistant bacterium sis (Frateur 1950) comb. nov., and Aceto- etobacter cibinongensis (a recent case may be an emerging opportunistic bacter estunensis (Carr 1958) comb. nov. of bacteremia in a patient receiving pathogen in immunocompromized J Gen Appl Microbiol. 2000;46:147–65. chronic hemodialysis for end-stage re- patients, including CF patients with a 9. Lisdiyanti P, Kawasaki H, Seki T, Yamada Y, Uchimura T, Komagata K. Identifi ca- nal failure [7]). lung transplant. tion of Acetobacter strains isolated from A. indonesiensis has been isolated Indonesian sources, and proposals of Ac- from fruits and fl owers in Indonesia Fadi Bittar,* etobacter syzygii sp. nov., Acetobacter (8); only 3 reports on it have been Martine Reynaud-Gaubert,† cibinongensis sp. nov., and Acetobacter Pascal Thomas,† orientalis sp. nov. J Gen Appl Microbiol. published (3,8,9). In our patient, we 2001;47:119–31. believe that this multidrug-resistant Stéphanie Boniface,† 10. Poschet J, Perkett E, Deretic V. Hyper- bacterium was the primary cause of Didier Raoult,* acidifi cation in cystic fi brosis: links with the infection because the patient was and Jean-Marc Rolain* lung disease and new prospects for treat- ment. Trends Mol Med. 2002;8:512–9. eventually cured after an adapted an- *Unité de Research sur les Maladies In- fectieuses et Tropicales Emergentes, Mar- timicrobial drug therapy. Because Address for correspondence: Jean-Marc Rolain, seille, France; and †Hôpital Sainte Margue- this bacterium grows easily at acidic URMITE, CNRS-IRD UMR 6236, Faculté rite, Marseille pH (4), a classic condition in the CF de Médecine et de Pharmacie, 27 Blvd Jean airway surface liquid, acidity might References Moulin, 13385 Marseille, CEDEX 5, France; contribute to bacterial adhesion and email: [email protected] colonization (10). Because acetic acid 1. Coenye T, Goris J, Spilker T, Vandamme bacteria have never been isolated from P, Lipuma JJ. Characterization of unusual All material published in Emerging bacteria isolated from respiratory secre- Infectious Diseases is in the public human fl ora, the source of the con- domain and may be used and reprinted tamination for our patient remains un- tions of cystic fi brosis patients and descrip- tion of Inquilinus limosus gen. nov., sp. without special permission; proper known. nov. J Clin Microbiol. 2002;40:2062–9. citation, however, is required.

998 Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 14, No. 6, June 2008