Brevundimonas spp: Emerging global opportunistic pathogens

Figures & data

Table 1. Incidences of Brevundimonas spp. infection from 1978–2000 – Main characteristics of the case reports.

Author (Ref)/ Species	Year	Sex/Age	Country	Co-morbidity	Type of infection	Susceptible to	Resistance to	Antibiotic treatment	Outcome
Otto et al. [53], B. vesicularis	1978	Multiple cases (5 cases)	USA	N/A	Cervicitis	Ampicillin, Carbenicillin, Gentamicin, Kanamycin Nitrofurantoin, Streptomycin, Tetracycline	Colistin, Nalidixic acid, Sulfisoxazole	N/A	N/A
Vanholder et al. [54], B. vesicularis	1990	M/62	Belgium	Hemodialysis,	Bacteraemia/HA	N/A	N/A	Cefotaxime, Tobramycin	Complete recovery
Vanholder et al. [55], B. vesicularis	1992	F/62	Belgium	Hemodialysis,	Bacteraemia/HA	N/A	N/A	Cefotaxime, Tobramycin	Complete recovery
Planes et al. [56], B. vesicularis	1992	W/54	USA	Systemic lupus erythematosus and chronic active autoimmune hepatitis	Bacteraemia/HA	N/A	N/A	Ceftazidime, Tobramycin	Surgical resection of the infected tissue
Pasadakis et al. [57], B. diminuta	1993	N/A	Greece	End-stage renal failure	Peritonitis	N/A	N/A	Initial 500 mg/L ceftazidime in a I-L + 1.7 mg/kg of tobramycin. Maintenance doses 250 mg/2 L of ceftazidime + 16 mg/2 L of tobramycin	Complete recovery
Oberhelman et al. [58], B. vesicularis	1994	M/5	USA	Sickle cell anaemia	Pneumonia/CA	N/A	N/A	Ceftriaxone, Gentamicin	Complete recovery
Calegari et al. [59], B. vesicularis	1996	M/60	Uruguay	Trauma	Botryomycosis/CA	N/A	N/A	Cefuroxime	Complete recovery
Gilad et al. [60], B. vesicularis	2000	F/42	Israel	Mitral valve replacement	Bacteraemia/HA	Amoxicillin-Clavulanate, Amino-glycosides, Co-trimoxazole, Imipenem, Mezlocillin, Piperacillin, Piperacillin- Tazobactam	Ampicillin, Aztreonam, Cefuroxime, Ceftriaxone, Ceftazidime, Ciprofloxacin	Piperacillin- Tazobactam	Complete recovery

M- Male, F- Female, N/A – Not Available, CA – Community Acquired, HA- Hospital Acquired.

Table 2. Incidences of Brevundimonas spp. infection from 2001 – 2010. Main characteristics of the case reports.

Author (Ref)	Year	Sex/Age	Country	Co-morbidity	Type of infection	Susceptible to	Resistance to	Antibiotic treatment	Outcome
Lee et al. [61], Various	2000–2010	Multiple (30 cases)	Taiwan	Cancer patients	Bacteraemia	Ciprofloxacin, Colistin, Doripenem, Tigecycline	Amikacin, Piperacillin/tazobactam	Cefotaxime, Ceftazidime, Cefmetazole, Cefazolin, Cefuroxime, Ceftriaxone, Imipenem, Piperacillin/tazobactam, Ticaracillin-Clavulanate	Complete recovery
Seve et al. [62], B. diminuta	2004	F/35	France	Leukaemia	Bacteraemia/HA	Ciprofloxacin, Imipenem	Amikacin, Cefepime and Ceftazidime, Piperacillin	Initially Cefepime, Amikacin After susceptibility testing: Ciprofloxacin, Imipenem	Complete recovery
Chi et al. [63], B. vesicularis	2004	M/38	Taiwan	None	Tonsillitis/CA	Cefoperazone.	Ampicillin, Aztreonam, Cefazolin, Ceftazidime, Ciprofloxacin, Flomoxef, Gentamicin, Tobramycin	Amoxicillin/ Clavulanic acid	Complete recovery
Chi et al. [63], B. diminuta	2004	M/62	Taiwan	Liver cirrhosis, Encephalopathy, Spontaneous bacterial peritonitis	Bloodstream infection/CA	Amikacin, Aztreonam, Cefotaxime, Cefepime, Chloramphenicol, Ciprofloxacin Flomoxef, Gentamicin, Imipenem, Piperacillin-Tazobactam, Tetracycline, Tobramycin, Co-trimoxazole	Ampicillin, Cefazolin, Cefoperazone, Ceftazidime, Ceftriaxone	Cefotaxime	Complete recovery
Han et al., [46], B. diminuta	2005	Multiple (7 Cases)	USA	Cancer	Bacteraemia, Urinary Tract Infection, Empyema/HA	Amikacin, Imipenem and Ticarcillin/clavulanate	Ampicillin, Cefepime, Ciprofloxacin	Cefepime, Imipenem, Levofloxacin, Meropenem, Nafcillin, Tobramycin, Ticarcillin/ clavulanate, Vancomycin	Complete recovery
Karadag et al. [38], B. vesicularis	2005–2011	Multiple (8 cases)	Turkey	Neonates	Septicaemia/HA	Amikacin, Imipenem,	Aztreonam, Ceftazidime, Piperacillin/tazobactam	Ampicillin, Cefotaxime, Ciprofloxacin, Meropenem,	7 Complete recovery, 1 Died
Vahid [64] B. vesicularis	2005	W/36	USA	Acute myelogenous leukaemia	Bacteraemia	Ciprofloxacin, Ticaracillin-Clavulanate	Amikacin, Aztreonam, Cefepime, Ceftazidime, Ceftriaxone, Meropenem, Piperacillin/tazobactam	Initially: Amikacin, Ampohotericin B, Gancyclovir Vancomycin	Died
Papaefstathiou et al., [65], B. vesicularis	2005	F/92	Greece	Cardiac failure	Bacteraemia/CA	Amoxicillin-clavulanate, Aminoglycosides, Azlocillin, Aztreonam Second and Third-generation Cephalosporins, Imipenem, Piperacillin, Tetracycline, Trimethoprim-Sulfamethoxazole	Ampicillin, Cephalothin, Ciprofloxacin	Cefuroxime, Netilmicin	Died
Niedermeier et al. [66], B. vesicularis	2005	F/37	USA	Acute myeloid leukemia, Pregnancy, Pancytopenia	Sepsis/HA	N/A	N/A	Clindamycin, Piperacillin-tazobactam	Complete recovery from sepsis
Mondello et al. [67], B. vesicularis	2006	M/24	Italy	Pilocytic astrocytoma	Meningitis/HA	Ciprofloxacin, Co-trimoxazole, Tetracycline	N/A	Initially: Ceftriaxone, Ciprofloxacin, Co-trimoxazole After Treatment failure: Amikacin	Complete recovery
Choi et al. [68], B. vesicularis	2006	M/55	South Korea	Diabetes, Continuous ambulatory peritoneal dialysis	Peritonitis/CA	N/A	N/A	Aztreonam, Cefazolin, Ceftazidime, Ciprofloxacin, Vancomycin	Complete recovery
Yang et al. [69], B. vesicularis	2006	M/40	Taiwan	None	Endocarditis/ CA	Amikacin, Amoxicillin, Gentamicin, Piperacillin, Aztreonam, Cefepime, Meropenem, Netilmicin, Ampicillin, Ciprofloxacin, Cefazolin, Cefmetazole, Ceftazidime, Cefotaxime, Ceftriaxone, Ticarcillin	N/A	Cefazolin, Gentamicin	Complete recovery
Zhang et al. [70], B. vesicularis	2006–2009	Multiple Cases (22 patients)	Taiwan	Various (Cancer, heart failure, COPD, Kidney diease)	Bacteraemia/CA/HA	Amikacin, Cefpirome, Imipenem, Piperacillin/tazobactam,	N/A	Various (Penicillin's, Cephalosporins)	Complete recovery in 21 cases. 1 case of death
Pelletier et al. [71], B. vesicularis	2007	F/45	USA	None	Keratitis	Ceftazidime, Ciprofloxacin, Gentamicin, Levofloxacin	N/A	Ceftazidime	Complete recovery
Sofer et al., [72], B. vesicularis	2007	F/15 Month old	Israel	None	Septic Arthritis/CA	Aminoglycosides, Aminopenicillins, Cephalposporins, Piperacillin, Quinolones, Trimethoprim-sulfamethoxazole	N/A	Cefuroxime	Complete recovery
Menuet et al. [29], B. vesicularis	2008	F/17	France	Cystic Fibrosis	Pneumonia	Amikacin, Ceftriaxone, Gentamicin, Imipenem, Isepamicin, Rifampicin, Piperacillin/tazobactam, Ticarcillin, Ticarcillin- Clavulanate, Tobramycin	Amoxicillin, Amoxicillin-Clavulanate, Ceftazidime, Ciprofloxacin, Colistin, Trimethoprim-Sulfamethoxazole	Imipenem, Tobramycin	Complete recovery
Panasiti et al. [73], B. vesicularis	2008	M/71	Italy	None	Cutaneous Infection/CA	Amikacin, Cefoxitin, Ceftazidime, Cefuroxime, Cefalotin, Cepodoxime, Gentamycin, Tobramycin	Amoxicillin-Clavulanate, Cefeoime, Ofloxacin, Norfloxacin	Amoxicillin-Clavulanate	Complete recovery
Viswanathan et al. [74], B. vesicularis	2009	M/Infant	India	Newborn	Sepsis/HA	Amikacin, Cefotaxime, Ciprofloxacin, Gentamicin, Meropenem, Ofloxacin, Piperacillin tazobactam	N/A	Amikacin, Cefotaxime	Complete recovery
Chandra et al. [75], B. vesicularis	2010	M/31	USA	Biliary Pancreatitis	Bacteraemia	Amikacin, Cefuroxime, Cefepime, Ciprofloxacin, Gentamicin, Piperacillin/tazobactam, Polymyxin B,	Aztreonam.	Cefuroxime	Complete recovery
Restrepo et al. [76], B. vesicularis	2010	F/44	Columbia	None known	Reactive Arthritis + Bacteraemia	Amikacin, Imipenem, Meropenem, Piperacillin/tazobactam	Aztreonam, Ciprofloxacin	Initially: Amikacin, Ciprofloxacin Following Sensitivity testing: Piperacillin/tazobactam	Complete recovery
Estrela and Abraham [77] B. vancanneytii	2010	N/A	Germany	N/A	Endocarditis	N/A	N/A	N/A	N/A

M- Male, F- Female, N/A – Not Available, CA – Community Acquired, HA- Hospital Acquired.

Table 3. Incidences of Brevundimonas spp. infection from 2010 – 2017. Main characteristics of the case reports.

Author (Ref)	Year	Sex/Age	Country	Co-morbidity	Type of infection	Susceptible to	TResistance to	Antibiotic treatment	Outcome
Shang et al. [78], B. vesicularis	2011	M/83	Taiwan	Type 2 diabetes, Hypertension	Progressive leucocytosis/HA	Amikacin, Ampicillin/Sulbactam, Cefazolin, Ceftazidime, Ceftriaxone, Cefepime, Ertapenem, Gentamicin, Imipenem, Piperacillin/Tazobactam	Ampicillin, Ciprofloxacin	N/A	Complete recovery
Shang et al. [78], B. vesicularis	2011	M/25	Taiwan	Lymphoma	Febrile neutropenia/HA	Amikacin, Ampicillin/Sulbactam, Cefazolin, Ceftriaxone, Ertapenem, Gentamicin, Imipenem, Piperacillin/Tazobactam	Ampicillin, Ceftazidime, Cefepime, Ciprofloxacin	Ceftriaxone	Complete recovery
Bhatawadekar & Sharma [79] B. vesicularis	2011	F/Infant	India	Infant	Bacteraemia/CA	Amikacin, Amoxicillin, Cefotaxime, Ciprofloxacin, Gentamicin, First Generation Cephalosporins, Imipenem, Meropenem, Piperacillin, Ticarcillin	Ceftazidime, Cefoxitin, Co-trimaxazole,, Netilmicin	Cefotaxime	Complete recovery
Yoo et al. [80], B. vesicularis	2012	M/30	South Korea	N/A	Liver Abscess	Amikacin, Ampicillin-Sulbactam, Imipenem	Aztreonam, Ceftazidime, Cefepime, Ciprofloxacin	Ceftriaxone, Ampicillin-Sulbactam	Complete recovery
Almuzara et al. [47], B. diminuta	2012	F/56	Argentina	Lupus glomerulonephritis	Leg ulcer	Minocycline, Tigecycline	Ampicillin, Ampicillin/Sulbactam, Aztreonam, Cefalotin, Cefoxitin, Cefotaxime, Ceftazidime, Cefepime, Ciprofloxacin, Colistin, Gentamicin, Imipenem, Meropenem, Piperacillin/Tazobactam, Trimethoprim- sulfamethoxazole	Tigecycline plus imipenem.	Complete recovery
Karadag et al. [81], B. vesicularis	2012	M/Infant	Turkey	Neonate	Neonatal sepsis	Amikacin, Ceftriaxone, Gentamicin, Imipenem	Ampicillin, third-generation Cephalosporins, piperacillin-tazobactam	Empirical Ampicillin, Gentamicin. After susceptibility testing Meropenem followed by ciprofloxacin	Complete recovery
Khalifa  et al. [48], B. vesicularis	2012	F/Infant	Tunisia	Pompe disease	Bacteraemia	Amikacin, Aztreonam Cefotaxime, Ceftazidime, Ciprofloxacin, Gentamicin, Imipenem, Ofloxacin, Piperacillin/ tazobactam	Ppiperacillin, Ticarcillin	Ceftazidime 100 mg / kg daily for 10 days and Amikacin 15 mg / kg daily	Complete recovery
Pandit et al. [82], B. diminuta	2012	F/66	USA	N/A	Keratitis/CA	Amikacin, Gentamicin, Tobramycin	Ampicillin, Cefotaxime, Ceftazidime, Ciprofloxacin, Moxifloxacin	Besifloxacin and Tobramycin, Following identification Tobramycin was changed to Gentamicin	Complete recovery
Lu et al. [45], B. diminuta	2013	M/38	China	None	Pleuritis	Amikacin, Chloramphenicol, Gentamicin, Cefoperazone-Sulbactam, Meropenem, Piperacillin/tazobactam, Tetracycline	Aztreonam, Ceftazidime, Cefepime, Ciprofloxacin, Levofloxacin, Trimethoprim-sulfamethoxazole	Initially: Ciprofloxacin After Treatment failure: Piperacillin/tazobactam	Complete recovery
Nandy et al. [83], B. vesicularis	2013	F/Infant	India	Infant	Bacteraemia	Meropenem, Ceftazidime/ Clavulanic acid, Netilimycin, Cefepime, Ampicillin/Sulbactam, Piperacillin/Tazobactam, Levofloxacin, Ciprofloxacin, Ceftazidime, Tobramycin, Gentamicin	Cotrimaxazole, Nalidixic acid	Piperacillin/ Tazobactam, Amikacin, Gentamycin, Fluconazole, Ciprofloxacin, Meropenem	Complete recovery
Shobha et al. [84], B. diminuta	2013	Infant	India	None	Urinary Tract Infection	Amikacin, Amoxicillin-Clavulanic acid, Cefotaxime, Cefepime, Imipenem, Ticarcillin/clavunalic acid, Trimethoprim–sulfamethoxazole	Ampicillin, Ciprofloxacin	Ticarcillin/clavulanic acid	Complete recovery
Gupta et al. [49], B. vesicularis	2014	M/24	India	None	Urinary Tract Infection	Minocycline, Piperacillin/tazobactam Trimethoprim–sulfamethoxazole	Amikacin, Amoxicillin, Amoxicillin-Clavulanate, Aztreonam Ceftazidime, Cefoperazone, Cefoperazone-Sulbactam, Cefoxitin, Cefotaxime, Colistin, Ertapenem, Gentamicin, Imipenem, Levofloxacin, Meropenem, Netilmicin, Norofloxacin, Tobramycin	Amikacin, Piperacillin/tazobactam	Complete recovery
Shujat et al. [85], B. vesicularis	2014	F	Pakistan	Gall Bladder issues	Bacteraemia	N/A	N/A	Meropenem	Complete recovery
Kishore [86] B. vesicularis	2014	M/51	India	Diabetes Mellitus (Type 2), Coronary Artery Disease	Bacteraemia	N/A	Ampicillin-Sulbactam	Amikacin, Amoxyclav	Complete recovery
Mahapatra et al. [87], B. diminuta	2014	M/35	India	N/A	Post traumatic abscess	N/A	N/A	N/A	Complete recovery
Ra et al. [88], B. vesicularis	2015	F/71	South Korea	End stage renal disease, Hypertension and diabetes mellitus	peritoneal dialysis-associated peritonitis	Cefepime, Cefotaxime, Gentamicin, Imipenem, Piperacillin	N/A	1-g dose of Cefazolin and 1-g dose of Ceftazidime per day	Complete recovery following catheter removal
Cao et al. [89], B. diminuta	2015	M/62	China	Myelodysplastic syndrome, Diabetes Mellitus (Type 2)	Bacteraemia	Ampicillin, Amikacin, Ceftriaxone, Cefepime, Cefazolin, Ceftazidime, Ciprofloxacin, Gentamicin, Imipenem, Levofloxacin, Piperacillin/tazobactam Trimethoprim–sulfamethoxazole	Aztreonam, Tobramycin	N/A	Complete recovery
Singh and Bhatia [90] B. vesicularis	2015	8 month old	India	Infant	Septicaemia/ CA	Amikacin, Cefoperazone, Levofloxacin, Piperacillin/tazobactam	Amoxicillin-Clavulanate, Ceftazidime	Initially: Amikacin, Ceftriaxone, Vancomycin Following Sensitivity testing: Cefoperazone, Levofloxacin,	Complete recovery
Chandra et al. [91], B. vesicularis	2017	M/18	India	Nephrotic syndrome	Nephrotic syndrome	imipenem, meropenem, amikacin, gentamicin, fluoroquinolones, minocycline, tigecycline, cefoperazone-sulbactam, ceftazidime, cefepime, and cotrimoxazole	Colistin	cefoperazone-sulbactam 1.5 g iv BD for 2 weeks	Complete recovery
Swain and Rout [92] B. diminuta	2017	M/56	India	Type-2 diabetes mellitus, hypertension with epileptic disorder	Bacteraemia	Amikacin, Ceftazidime, Ceftazidime/clavulanic acid, Cefuroxime, Ceftriaxone, Ciprofloxacin, Levofloxacin, Netilimycin	Amoxicillin/clavulanic acid	Amikacin, Ceftazidime	Complete recovery

M- Male, F- Female, N/A – Not Available, CA – Community Acquired, HA- Hospital Acquired.

Table 4. Molecular methods applied to identify Brevundimonas spp. [45].

Method	Target	Sequence	Species
Real Time PCR	gyrB	Forward Primer	Brevundimonas diminuta
		ATCGAGATCATGCTGCACTATGAGGG
		Reverse Primer
		TGTTGTTGGTGAAGCACAGCATGG
		Real-Time Probe
		ACGTCATCGTCATTCGCGGCCAGAA
Real Time PCR	rpoD	Forward Primer AGTTCCTCAAGGCCTATTTCGGCT	Brevundimonas diminuta
		Reverse Primer
		GGCTTCATTCTCGCTGAACTTGGT
		Real-Time Probe
		AGCGCATCAAGGAGATGGGCGT
FISH	gyrB	AAGAAGCACAGCGTCCGCTTCGAGC	Brevundimonas diminuta
FISH	rpoD	TCAAGGCCTATTTCGGCTCGGAGAT	Brevundimonas diminuta

Table 5. Incidences of Brevundimonas spp. Pseudo-infection from 1978 – 2017. Main characteristics of the case reports.

Author (Ref)	Year	Sex/Age	Country	Co-morbidity	Type of infection	Susceptible to	Resistance to	Antibiotic treatment	Outcome
Kim et al. [50], B. diminuta	2011	Multiple (3 cases)	South Korea	Multiple	Pseudobacteraemia	N/A	Amikacin, Ciprofloxacin, Colistin, Ceftazidime, Cefepime, Cefotaxime Imipenem, Piperacillin / Tazobactam, Tobramycin	Ampicillin / sulbactam, Cefpiran, Metronidazole, Netilmicin	N/A
Lee et al. [51], B. diminuta	2017	Multiple (12 cases)	USA	Multiple	Pesudo-infection	Levofloxain, Meropenem, Piperacillin/tazobactam, Trimethoprim–sulfamethoxazole	Ceftazidime	N/A	N/A

M- Male, F- Female, N/A – Not Available

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