Infection and Drug Resistance (May 2023)
A Rare Strain Actinomadura geliboluensis Was First Isolated from the Bronchoalveolar Lavage Fluid of a Patient with Pneumonia
Abstract
Yefu Yu,1,* Guier Yang,2,* Yanan Wang,1 Faxiang Jin,1 Huiyu Wang,1 Zhongqiang Yu,3 Lanqing Li,4 Xiangcheng Li,4 Junshun Gao,4 Wenfang Xu1 1Department of Clinical Laboratory, Affiliated Hospital of Shaoxing University, Shaoxing, 312000, People’s Republic of China; 2Emergency Ward of Affiliated Hospital of Shaoxing University, Shaoxing, 312000, People’s Republic of China; 3Department of Imaging, Affiliated Hospital of Shaoxing University, Shaoxing, 312000, People’s Republic of China; 4Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, Hangzhou, 310016, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wenfang Xu, Department of Clinical Laboratory, Affiliated Hospital of Shaoxing University, 999 Zhongxing South Road, Yuecheng District, Shaoxing, People’s Republic of China, Tel +8613857589470, Email [email protected] Junshun Gao, Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research of Zhejiang Province, 3 Qingchun East Road, Shangcheng District, Hangzhou, People’s Republic of China, Email [email protected]: Actinomadura geliboluensis was first isolated in 2012 in Gelibolu, Canakkale, Turkey, and has not been reported to be isolated from humans until now. We have isolated it from the bronchoalveolar lavage fluid (BLF) of a patient with pneumonia and found its drug resistance. It is the first time that Actinomadura geliboluensis has been isolated from humans since its discovery and naming. This case may provide new ideas and methods for the clinical diagnosis and treatment of pulmonary actinomycosis.Case Description: The patient was a 75-year-old male who was hospitalized in a township hospital and failed to improve after penicillin treatment. After admission to our hospital, the patient was treated with piperacillin/tazobactam according to clinical guidelines for 14 days. Actinomadura geliboluensis was isolated from the patient’s BLF and was identified by 16S rRNA sequencing. This report shows the biological characteristics and in vitro drug susceptibility testing, as well as the genomics analysis based on next-generation sequencing (NGS). The results demonstrated that Actinomadura geliboluensis was easy to be mistakenly identified as Actinomyces dental caries by using the Merieux ANC identification card. Based on the MIC test, Actinomadura geliboluensis was susceptible to tetracyclines, quinolones and sulfonamides, but resistant to carbapenems, penicillins and cephalosporins. The K-B test results showed Actinomadura geliboluensis was highly sensitive to piperacillin/tazobactam. Genomic analysis based on NGS showed that the Actinomadura geliboluensis belongs to Planobispora rosea EF-Tu mutants conferring resistance to inhibitor GE2270A, AAC(3)-VIIa, vanRO, chrB, and mexY.Conclusion: Actinomycetes is generally sensitive to Penicillin but Actinomadura geliboluensis is not. In vitro drug susceptibility test is needed to support individualized drug use to avoid delay in the disease.Keywords: Actinomadura geliboluensis, pulmonary actinomycosis, antibiotic resistance, next generation sequencing, genomics
