25th ECCMID EMERGING ROLE OF RAOULTELLA ORNITHINOLYTICA IN HUMAN INFECTIONS, MARSEILLE, FRANCE. Copenhagen, Denmark Piseth Seng*, Boushab Mohamed Boushab, Frédérique Gouriet, Fanny Romain, Nicolas Bruder, Claude Martin, Franck Paganelli, April 25th - 28th, 2015 Emmanuelle Bernit, Yves Patrice Le Treut, Pascal Thomas, Laurent Papazian, Didier Raoult and Andreas Stein Service des Maladies Infectieuses, Hôpital de la Conception; URMITE, CNRS UMR 6236, Faculté de Médecine, 27 Bd Jean Moulin, 13385 Marseille Cedex 05, France Poster : P0138

BACKGROUND RESULTS Raoultella ornithinolytica (formerly ornithinolytica) is known to During the study period, 225 isolates were identified i.e. 121 isolates with conventional inhabit aquatic environments and has been reported to survive commensally in phenotypic identification and molecular identification and 104 isolates with MALDI-TOF MS. human saliva. However, its significance as a clinical pathogen remains Among the 187 R. ornithinolytica isolates identified with clinical information, 71 isolates were disregarded. considered as colonized and 116 isolates were pathogen. (Table 1) We have identified a total of 112 cases of R. ornithinolytica infections. Urinary tract infection, gastrointestinal infections, wounds and skin infections, and bacteremia were observed in 36%, MATERIAL & METHODS 14%, 13% and 5% of cases, respectively. Associated infections that have never been reported, We performed a review of 112 cases of R. ornithinolytica that were such as respiratory infections i.e. pneumonia and pleural effusion, were observed in 24% of encountered in our centers from 2001 to 2013. From 2002 January to 2009 cases. Additional diseases reported for the first time in this study include bone and joint August, R. ornithinolytica isolate were identified with routine phenotypic i.e. infections, meningitis, cerebral abscess, mediastinitis, pericarditis, conjunctivitis and otitis. semi-automated Gram staining (Aerospray Wiescor; Elitech) and Vitek 2 system (Table 2) (BioMérieux), with 330 microorganism strains as references. Correct Resistance to ceftriaxone, quinolone and cotrimoxazole was observed in 4%, 5% and 9% of cases, identification of R. ornithinolytica was done when the T index was ≥ 0.25. All of respectively. 92% of cases were discharged, and 8% of cases were died i.e. 6 cases for septic R. ornithinolytica isolates were identified with certainty using molecular shock and 3 cases for cancer. The number of R. ornithinolytica isolate identification has identification using 16S rRNA. From 2009 September to 2013 December, R. increased from 16 isolates to 24 isolates yearly identified after arriving of MALDI-TOF MS in Fig. 1. Number of R. ornithinolytica isolates identified and infection cases in our centers ornithinolytica isolate were exclusively identified with MALDI-TOF MS. We our laboratory, which is proportional to increasing of global number of bacterial identification in have also reviewed the 23 cases in the literature. our laboratory. Nevertheless, the identification of R. ornithinolytica isolate become easy without DISCUSSION & CONCLUSION the confirmation by molecular procedure. (Fig. 1). We reported 112 cases R. ornithinolytica humans infection that were managed in our centers Table 1. Distribution of the sources of clinical samples for R. ornithinolytica over the last 12 years. To our knowledge, 23 cases of R. ornithinolytica infection have been isolates identified in our laboratory during the 12-year study period. Table 2. Clinical relevance of the 112 R. ornithinolytica infection cases in our study. reported in the literature. Sources of clinical samples all of 225 R. of 116 R. of 71 R. of 38 R. Types of infections Number of cases (%) Previously described comorbidities and risk factors reported in the literature such as solid ornithinolytica ornithinolytica ornithinolytica ornithinolytica Urinary tract infection 36 (32%) cancer, post-urethra trauma and post invasive procedures have been observed in our study. Cystitis 25 (22%) isolates (identified isolates (=112 isolates isolates (no Moreover, we found that one third of our patients have diabetes mellitus and during study infection (colonized clinical relevance Prostatitis 8 (7%) period) cases) cases) cases) Pyelonephritis 3 (3%) immunodeficiency. Among invasive procedures, the number of infection cases involving urinary Respiratory infection 27 (24%) catheters was high (34 cases); and new infection cases involving mechanical ventilation and/or Urine 95 36 44 15 Pneumonia 20 (18%) port catheters have been observed in our study. The relationship of R. ornithinolytica Pleural effusion 7 (6%) Respiratory samples 58 31 16 11 Gastrointestinal infection 16 (14%) infection with invasive procedures has not been frequently mentioned in the literature. Sputum 16 0 16 0 Cholangitis 8 (7%) Total number of R. ornithinolytica isolate identification has increased after arriving of Trans-bronchial catheter Pancreatitis 4 (4%) 27 20 0 7 MALDI-TOF MS in our laboratory and MALDI-TOF MS provides a rapid and reliable aspiration Peritonitis 4 (4%) identification of R. ornithinolytica . Pulmonary biopsy 2 1 0 1 Wound and skin infection 15 (13%) Cellulitis 13 (12%) The number of R. ornithinolytica infection cases has been underreported. R. ornithinolytica Bronchoalveolar lavage 6 3 0 3 Skin abscess 1 (1%) infections have become an emerging hospital-acquired infection that is specifically associated Pleural fluid 7 7 0 0 Breast abscess 1 (1%) with invasive procedures. Physicians should consider the increasing resistance among R. Bloodstream 18 7 0 11 Bacteremia 6 (5%) ornithinolytica clinical isolates when prescribing immediate broad-spectrum antibiotic Deep sample 20 20 0 0 Port Catheters infection 4 (4%) treatment for such infections until accurate microbiological results have been obtained. Peritoneal fluid 4 4 0 0 Mediastinitis 2 (2%) Arterial catheter infection 1 (1%) Bile 2 2 0 0 Aortic bi-femoral prosthesis infection 1 (1%) REFERENCES Pericardial effusion 1 1 0 0 Pericarditis 1 (1%) 1. Drancourt M et al. Phylogenetic analyses of Klebsiella species delineate Klebsiella and Raoultella gen. nov., with Skin and wound samples 24 15 9 0 Bone and joint infection 4 (4%) description of Raoultella ornithinolytica comb. nov., comb. nov. and comb. Wound swabs 9 0 9 0 Chronic osteitis without osteosynthesis device 3 (3%) nov. Int. J. Syst. Evol. Microbiol. 51:925–932. Surgical skin biopsy 15 15 0 0 Tibia pandiaphysitis 1 (1%) 2. De Jong E et al. Differentiation of Raoultella ornithinolytica/planticola and clinical isolates by Central Nervous System Infection 2 (4%) Milk 1 0 1 0 matrix-assisted laser desorption/ionization-time of flight mass spectrometry. Diagn. Microbiol. Infect. Dis. 75:431– Meningitis 3 (3%) 433. Conjunctiva of newborn 1 0 1 0 Cerebral abscess 1 (1%) 3. Park JS et al. Evaluation of three phenotypic identification systems for clinical isolates of Raoultella Strain identification (out of Conjunctivitis 2 (2%) 1 0 0 1 ornithinolytica. J. Med. Microbiol. 60:492–499. laboratory) External otitis 2 (2%) *Corresponding author: Piseth Seng, E-mail: [email protected]