Agrobacterium radiobacter bacteremia in a child with acute lymphoblastic leukemia
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Agrobacterium radiobacter bacteremia in a child with acute lymphoblastic leukemia Elpis Mantadakis, Anna Kondi, Athanassia Christidou, Maria Kalmanti Heraklion, Greece
Methods: The authors describe a 7-year-old boy with acute lymphoblastic leukemia who carried a central venous catheter and developed bacteremia due to Agrobacterium radiobacter (A. radiobacter). Results: Microbiological cure was achieved after administration of systemic ceftriaxone along with gentamicin lock therapy to the central venous catheter for 10 days. Catheter removal was not required, and the patient has not relapsed with bacteremia due to the same pathogen for more than 6 months. Conclusions: A. radiobacter is an emerging pathogen affecting immunocompromised children, particularly those with leukemia who carry central venous catheters. Although it has a low virulence, erratic susceptibility patterns, and high frequency of resistance to many antibiotics, ceftriaxone appears to be successful in treatment of most cases. Catheter removal for the clearance of bloodstream infections due to A. radiobacter may not be required in selected patients like the present case. World J Pediatr 2010;6(2):181-184 Key words: Agrobacterium radiobacter; bacteremia; central venous catheters; leukemia
Author Affiliations: Department of Pediatrics, Democritus University of Thrace and University District Hospital of Alexandroupolis, Thrace, Greece (Mantadakis E); Department of Pediatric Hematology/Oncology, University Hospital of Heraklion, 71 110 Heraklion, Crete, Greece (Kondi A, Kalmanti M); Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, 71 110 Heraklion, Crete, Greece (Christidou A) Corresponding Author: Maria Kalmanti, MD, PhD, Department of Pediatric Hematology/Oncology, University Hospital of Heraklion, PO Box 2208, Heraklion, Crete, Greece (Tel: +30-2810-392630; Fax: +30-2810-392778; Email: [email protected]) doi:10.1007/s12519-010-0018-1 ©Children's Hospital, Zhejiang University School of Medicine, China and Springer-Verlag Berlin Heidelberg 2010. All rights reserved.
Introduction
A
grobacterium radiobacter (A. radiobacter) is a rare opportunistic Gram-negative bacillus associated with bacteremia caused by indwelling central venous catheters (CVCs) or other implantable devices. [1-5] We present a 7-year-old boy with acute lymphoblastic leukemia (ALL) who developed bacteremia caused by A. radiobacter and was successfully treated without catheter removal with intravenous ceftriaxone and antibiotic lock therapy to the catheter with local gentamicin.
Case report
Background: Agrobacteria are Gram-negative tumorigenic plant pathogens that rarely cause infections in humans.
Case report
A 7-year-old boy with ALL and asthma who was receiving maintenance chemotherapy with oral methotrexate and 6-mercaptopurine and pulses of oral dexamethasone and intravenous vincristine every 10 weeks, according to one of the two arms of the mediumrisk ALL-BFM95 protocol, presented with fever up to 39.
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