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Volume 29, Number 3—March 2023
Research Letter

Inquilinus limosus Bacteremia in Lung Transplant Recipient after SARS-CoV-2 Infection

Eric FarfourComments to Author , Mathilde Zrounba, Antoine Roux, Hélène Revillet, Alexandre Vallée, and Marc Vasse
Author affiliations: Hôpital Foch, Suresnes, France (E. Farfour, M. Zrounba, A. Roux, A. Vallée, M. Vasse); CHU de Toulouse, Toulouse, France (H. Revillet); Observatoire National Burkholderia cepacia, Toulouse (H. Revillet); UMRS 1176, le Kremlin-Bicêtre, Paris-Saclay, France (M. Vasse)

Main Article

Table

Timeline of events in study of Inquilinus limosus bacteremia in lung transplant recipient with history of chronic graft dysfunction and prolonged SARS-CoV-2 infection, France, 2022*

Date Symptoms and clinical conditions CT scan findings Microbiologic findings Treatment
Mar 1
 Rhinorrhea
SARS-CoV-2 RT-PCR positive (Ct = 18.5)
 Symptomatic treatment
Mar 14
 Productive cough with greenish sputum
SARS-CoV-2 RT-PCR positive (Ct = 17.0)
 Amoxicillin/clavulanate 1.5 g/d for 7 d
Mar 29
 No improvement
Amoxicillin/clavulanate 1.5 g/d continued for 14 d; oseltamivir added for 5 d
Apr 11
 No improvement
 Bilateral nodular opacities
 Sputum grew 106 CFU/mL of Pseudomonas aeruginosa, resistant to ticarcillin, piperacillin, and carbapenem and susceptible to ceftazidime, cefepime, tobramycin, and ciprofloxacine (EUCAST 2021 guidelines); SARS-CoV-2 RT-PCR positive (Ct = 23.2)
 Cefepime 2 g/d for 11 d
Apr 22
 Condition worsened; patient hospitalized
 Discordant evolution with reduction of some lesions but appearance of new condensations and ground-glass opacities
 SARS-CoV-2 RT-PCR positive (Ct = 26.4)
 Piperacillin/tazobactam 8 g/d for 5 d; tobramycin 5 mg/kg, 1 shot
Apr 23
Sputa grew 106 CFU/mL of I. limosus and 103 CFU/mL of a cephalosporin-susceptible P. aeruginosa
Apr 24
Sputa grew 106 CFU/mL of I. limosus and 103 CFU/mL a cephalosporin-susceptible P. aeruginosa
Apr 25
BAL grew 104 CFU/mL of I. limosus, 102 CFU/mL, cephalosporin-susceptible P. aeruginosa, and few colonies of Aspergillus fumigatus
Apr 26
 Persistent cough and colored sputum
SARS-CoV-2 RT-PCR positive (Ct = 23.1)
 Ceftolozane/tazobactam 0.75 g d
Apr 29
Sputa grew 106 CFU/mL of I. limosus and 105 CFU/mL of P. aeruginosa
Apr 30
 Fever, no respiratory improvement
1 vial of a blood culture set sampled on April 26 was positive for a gram-negative rod after 87 h of incubation
 Posaconazole 300 mg/d
May 2
 Apyrexia
Meropenem 2 g/d for 2 d; amikacin 0.75 g, 1 shot
May 3
Gram-negative rod isolated from the blood culture identified as I. limosus; antimicrobial susceptibility testing results
May 4
Increased ground-glass opacities and bilateral condensations
Ciproflxoacin 1 g/d
May 5
SARS-CoV-2 RT-PCR positive (Ct = 27.6); BAL grew 104 CFU/mL of I. limosus
May 12
 Respiratory improvement
SARS-CoV-2 RT-PCR positive (Ct = 29.8)
July 21 Sputa grew 106 CFU/mL of I. limosus and 106 CFU/mL of P. aeruginosa

*Blank cells indicate no report. CT, computed tomography; Ct, cycle threshold; EUCAST, European Committee on Antimicrobial Susceptibility Testing; RT-PCR, reverse transcription PCR.

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Page created: January 12, 2023
Page updated: February 20, 2023
Page reviewed: February 20, 2023
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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