Rhodococcus infection: a 10-year retrospective analysis of clinical experience and antimicrobial susceptibility profile

Abstract

Rhodococcus equi is an opportunistic pathogen known to cause pulmonary and extrapulmonary disease among immunocompromised patients. Treatment is frequently challenging due to intrinsic resistance to multiple antibiotic classes. While non-equi Rhodococcus spp. are prevalent, their clinical significance is poorly defined. There is also limited data on antibiotic susceptibility testing (AST) of Rhodococcus infection in humans. We conducted a single-center, retrospective cohort study evaluating clinical characteristics, microbiologic profile, and AST of Rhodococcus infections between June 2012 and 2022 at our tertiary academic medical center. Identification of Rhodococcus spp. was performed by Sanger 16S rRNA gene sequencing and/or matrix-assisted laser desorption ionization-time of flight mass spectrometry, and AST was performed by agar dilution. Three hundred twenty-two isolates of Rhodococcus spp. were identified from blood (50%), pulmonary (26%), and bone/joint (12%) sources. R. equi/hoagii, R. corynebacterioides, and R. erythropolis were the most frequently isolated species, with 19% of isolates identified only to genus level. One hundred ninety-nine isolates evaluated for AST demonstrated high-level resistance to amoxicillin/clavulanate, cephalosporins, and aminoglycosides. More than 95% susceptibility to imipenem, vancomycin, linezolid, rifampin, and clarithromycin was observed. Non-equi species showed a significantly more favorable AST profile relative to R. equi. Clinically significant Rhodococcus infection was rare with 10 cases diagnosed (majority due to R. equi) and managed. The majority of patients received 2- or 3-drug combination therapy for 2-6 months, with favorable clinical response. Significant differences in AST were observed between R. equi and non-equi species. Despite high antimicrobial resistance to several antibiotic classes, imipenem and vancomycin remain appropriate empiric treatment options for R. equi. Future research evaluating mechanisms underlying antimicrobial resistance is warranted.

Keywords: Rhodococcus; antibiotic resistance; bone marrow transplantation; immunocompromised hosts; susceptibility testing; transplant infectious diseases.

Fig 1

Microbiologic profile of Rhodococcus infection including (A) annual trends in Rhodococcus isolate identification, (B) sources of isolates, and (C) species-level identification.

Fig 2

Antimicrobial susceptibility profile of Rhodococcus species with MIC distribution of oral and intravenous antibiotics evaluated. Abbreviations: MIC, minimum inhibitory concentration; TMP-SMX, trimethoprim/sulfamethoxazole; S, susceptible; I, intermediate; R, resistant. CLSI interpretive criteria for susceptible or resistant isolates used the most current CLSI interpretive table for Nocardia and other aerobic actinomycetes such as Rhodococcus species (21).

Fig 3

Rhodococcus equi and non-equi species antimicrobial susceptibility profile. Abbreviations: S, susceptible; I, intermediate; R, resistant.