Extensively drug-resistant Myroides odoratimimus – A case series of urinary tract infections in immunocompromised patients

Figures & data

Table 1 Clinical characteristics and treatment of the four cases of UTIs due to Myroides odoratimimus

Case no.,age (years)/gender	Department admitted to	Admission date	Collection date	Days of hospitalization	Comorbidities	Presence of an indwelling device	Prior antibiotic treatment	Type of infection	Treatment for MyroidesUTI	Outcome
Cl	Surgery	May 30, 2017	June 22, 2017	43	Pelvic abscess, anal condylomatosis,	Urethro-vesical	Imipenem,	UTI	None	Cured
36/M					kidney transplantation, hepatitis B infection	catheterization	amikacin, colistin
C2	Diabetes	June 19, 2017	June 27, 2017	9	Diabetes mellitus, above-knee	Urethro-vesical	None	UTI	Tigecycline	Good clinical
59/F					left amputation for PAD, obesity, hypertension	catheterization				response
C3	Urology	June 24, 2017	June 26, 2017	10	TUR-P for BPH, BNI for bladder	Urethro-vesical	None	UTI	Tigecycline	Good clinical
72/M					neck obstruction, COPD	catheterization				response
C4	Urology	August 3, 2017	August 3, 2017	2	Radical cystectomy for high-grade	Bilateral	None	Bladder	None	Favorable
57/M					papillary urothelial carcinoma stage pT2, obesity, hypertension	cutaneousureterostomy		colonization

Abbreviations: BNI, bladder neck incision; BPH, benign prostatic hyperplasia; PAD, peripheral artery disease; TUR-P, transurethral resection of prostate; UTI, urinary tract infection.

Table 2 In vitro susceptibility testing of the Myroides odoratimimus isolates

Antibiotic	Cl		C2		C3		C4
	MIC value	Interpretation	MIC value	Interpretation	MIC value	Interpretation	MIC value	Interpretation
	(Mg/mL)	(S, I, R)	(Mg/mL)	(S, I, R)	(Mg/mL)	(S, I, R)	(Mg/mL)	(S, I, R)
Ticarcillin	≥128	R	≥128	R	≥128	R	≥128	R
Piperacillin	≥128	R	≥128	R	≥128	R	≥128	R
Piperacillin/	64	I	≥128	R	≥128	R	≥128	R
tazobactam
Ceftazidime	≥64	R	≥64	R	≥64	R	≥64	R
Cefepime	32	R	≥64	R	≥64	R	≥64	R
Aztreonam	≥64	R	≥64	R	≥64	R	≥64	R
Imipenem	≥16	R	≥16	R	≥16	R	≥16	R
Meropenem	≥16	R	≥16	R	≥16	R	≥16	R
Amikacin	≥64	R	≥64	R	≥64	R	≥64	R
Gentamicin	≥16	R	≥16	R	≥16	R	≥16	R
Tobramycin	≥16	R	≥16	R	≥16	R	≥16	R
Ciprofloxacin	≥4	R	≥4	R	≥4	R	≥4	R
Pefloxacin	8	R	8	R	8	R	≥16	R
Minocycline	2	S	2	S	2	S	≥1	S
Colistin	≥16	R	≥16	R	≥16	R	≥16	R
Trimethoprim	≥320	R	≥320	R	≥320	R	≥320	R
sulfamethoxazole

Abbreviations: I, intermediate; MIC, minimum inhibitory concentration; R, resistant; S, susceptible.

Table 3 Reported cases of Myroides spp. strains isolated from the urine, as found in the USA National Library of Medicine (PubMed) database (May 12, 2017)

Case no.	Gender/age (years)	Clinical condition/indwelling device	Antibiotic resistance status	Treatment for MyroidesUTIs	Outcome	Report/year/reference
1	M/66	Bilateral hydronephrosis, bilateral ureteric stones/left DJ stent	Resistant to all beta- lactam and non-beta- lactam antibiotics,	Imipenem, colistin	Failure	Ktari et al/2012/19
2	M/44	Bilateral hydronephrosis, bilateral ureteric stones, left kidney stone/bilateral DJ stent	including imipenem, vancomycin, ciprofloxacin, chloramphenicol	No treatment (bladder colonization)	Favorable	Ktari et al/2012/19
3	M/44	Left ureteric stone/left DJ stent		No treatment (bladder colonization)	Favorable	Ktari et al/2012/19
4	M/47	BPH, bladder calculi		No treatment (bladder colonization)	Favorable	Ktari et al/2012/19
5	M/77	Right hydronephrosis, right ureteric stone/right DJ stent		Rifampicin + ciprofloxacin	Cured	Ktari et al/2012/19
6	M/65	BPH, bladder calculi, prostatitis		Rifampicin + ciprofloxacin	Cured	Ktari et al/2012/19
7	M/80	Bladder cancer		Rifampicin + ciprofloxacin	Cured	Ktari et al/2012/19
8-11 (four	ND/ND	Neoplasia of the urinary	Resistant to all 12	ND	ND	Yagci et al/2000/20
cases)		tract/catheterization	antimicrobial agents tested	ND	ND	Yagci et al/2000/20
			(amikacin, aztreonam,	ND	ND	Yagci et al/2000/20
			cefoperazone, ceftazidime,	ND	ND	Yagci et al/2000/20
12-20 (nine	ND/ND	Urinary calculi/	ceftriaxone, ciprofloxacin,	ND	ND	Yagci et al/2000/20
cases)		catheterization	gentamicin, imipenem,
21-29 (nine	ND/ND	ND	piperacillin, tetracycline,	ND	ND	Yagci et al/2000/20
cases)			tobramycin, trimethoprimsulfamethoxazole)
30	F/48	Cystitis (contaminant)	Fully resistant to	Furadantin	ND	Holmes et al/1979/27
31	F/59	ND (contaminant)	clinically obtainable	ND	ND	Holmes et al/1979/27
32	F/ND	Urinary retention (not clinically significant)	levels of streptomycin, kanamycin, gentamicin,	ND	ND	Holmes et al/1979/27
33	ND/ND	Not known	tobramycin, amikacin,	ND	ND	Holmes et al/1979/27
34	F/67	Total cystectomy, ileal loop urethrotomy (mixed culture)	ampicillin, carbenicillin, chloramphenicol,	ND	ND	Holmes et al/1979/27
35	M/48	Renal insufficiency, pyelonephritis, renal calculi (mixed culture)	tetracycline, polymyxin B, and erythromycin Resistant or	ND	ND	Holmes et al/1979/27
36	M/54	ND (very scanty numbers)	moderately sensitive	ND	ND	Holmes et al/1979/27
37	M/87	ND (mixed culture)	to sulfamethoxazole,	ND	ND	Holmes et al/1979/27
38	M/46	ND (Mixed culture)	cotrimoxazole,	ND	ND	Holmes et al/1979/27
39	M/59	ND (mixed culture)	cephaloridine and nalidixic	ND	ND	Holmes et al/1979/27
40	F/ND	ND (mixed culture)	acid	ND	ND	Holmes et al/1979/27
41	M/67	Multideficiency syndrome, pyelonephritis, liver disease (mixed culture)		ND	ND	Holmes et al/1979/27
42	M/38	Relapsing UTIs, bladder carcinoma		ND	ND	Holmes et al/1979/27
43	ND/ND	ND		ND	ND	Holmes et al/1979/27
44	M/ND	Syringomyelia/indwellingcatheter		ND	ND	Holmes et al/1979/27
45	F/ND	Relapsing urinary infection, renal insufficiency, hypertension		ND	ND	Holmes et al/1979/27
46	M/19	Spina bifida/permanent catheter		ND	ND	Holmes et al/1979/27
47	ND/ND	ND		ND	ND	Holmes et al/1979/27

Abbreviations: BPH, benign prostatic hyperplasia; DJ, double-J; ND, not described; UTI, urinary tract infection.