LAUSR

Cellulosimicrobium cellulans (formerly Oerskovia xanthineolyica), a nocardia-like bacillus widely distributed in the environent, is rarely associated with human infections.1 Cases reported o far in the literature are mostly related with the presence of forign bodies in immunocompromised patients.2 We describe a case f long-term recurrent catheter infection by C. cellulans. A 59-year-old woman with rectal adenocarcinoma and lung etastases, treated with bevazizumab through a Port-a-CathTM, resented to the emergency department with a 24-h history f fever. On examination, her temperature was 37.8 ◦C and difuse abdominal pain, related to current treatment, was observed. nflammatory signs were not observed in catheter’s insertion. -reactive protein (CRP) levels were elevated (63.4 mg/L) with noral blood cell count. A chest X-ray showed no other findings except hose related with patient’s basal condition. After admission, two ets of aerobic and anaerobic BD BACTEC Plus Blood Culture Bottles Becton Dickinson, Sparks, MD) were obtained and antipyretcs were initiated. Twenty-four hours later, both blood cultures BC) were positive for C. cellulans. Differential quantitative BC ere subsequently obtained and an intravenous vancomycin egimen (15 mg/kg/12 h) was initiated. On day +3 after admision, a differential time to positivity (DTP) between both BC as recorded, demonstrating a catheter-related bloodstream nfection caused by C. cellulans. Antimicrobial therapy was mmediately switched to vancomycin plus imipenem and conervative management of the catheter with antibiotic lock theapy was carried out. Lock therapy consisted of a 14-day course f instillations (5 mL of solution) with vancomycin (2 mg/mL soluion) plus heparin (20 IU/mL solution). On day +5, the patient was ischarged considering her clinical improvement. Lock therapy was ompleted after 14 days and control-BC were negative. However, 5 months later she returned to the emergency department with a -day history of fever, and was diagnosed of a device-related sepis. Biochemical tests showed elevated levels of CRP (327 mg/L) and