콩줄기에 찔린 후 Kosakonia cowanii에 의해 발생한 손 건초염

Abstract

A 77-year-old man with pain in his left hand after being pricked by a beanstalk visited an emergency center. Symptoms and laboratory findings suggested infectious tenosynovitis. Using the Bruker Biotyper (Bruker Daltonics, Germany), Kosakonia cowanii was identified in the swab culture and was confirmed by full-length 16S ribosomal RNA (rRNA) and gyrB sequencing. To the best of our knowledge, this is the first reported case of K. cowanii infection in Korea. Performing only 16S rRNA sequencing was insufficient for accurate identification, and gyrB sequencing or using the Bruker Biotyper (Bruker Daltonics, Germany) confirmed the identification. A positive sorbitol fermentation test can indicate the microorganism to be K. cowanii even if the VITEK 2 system (bioMérieux, France) identifies it as Pantoea spp. Additionally, K. cowanii may be resistant to beta-lactam antibiotics, including cefazolin; therefore, it may be appropriate to use carbapenems, third- or fourth-generation cephalosporins, aminoglycosides, fluoroquinolones, and trimethoprim/sulfamethoxazole. Finally, antibiotic susceptibility testing (AST) should be conducted using a reference method, and Etest AST is unreliable for K. cowanii, especially with beta-lactam/beta-lactamase inhibitors.