Sepsis Due to Pandoraea sputorum Infection After Multiple Trauma in a Non-Cystic Fibrosis Patient: A Case Report from Southeast China

Figures & data

Table 1 Antibiotic Susceptibility of Pandoraea Species from Blood and Wound Secretion Samples in Our Case

Samples	Blood (8.19)		Blood (8.23)		Wound Secertion (8.24)
Antibiotic/Suspecibility	MIC(mg/l)/ KB(mm)	S/R	MIC(mg/l)/ KB(mm)	S/R	MIC(mg/l)/ KB(mm)	S/R
Trimethoprim/Sulfamethoxazole	<=20	S	<=20	S	<=20	S
Piperacillin	≥128	R	≥128	R	–	–
Piperacillin/tazobactam	≥128	R	–	–	–	–
Cefazolin	≥64	R	≥64	R	≥64	R
Cefuroxime sodium	≥64	R	32	R	32	R
Ampicillin	≥32	R	≥32	R	≥32	R
Cefuroxime axetil	≥64	R	32	R	32	R
Cefotetan	≥64	R	≥64	R	≥64	R
Ceftazidime	≥64	R	≥64	R	≥64	R
Ceftriaxone	32	R	16	I	16	I
Cefepime	≥64	R	32	R	32	R
Aztreonam	≥64	R	≥64	R	≥64	R
Imipenem	21mm	S	<=1	S	2	S
Meropenem	≥16	R	≥16	R	≥16	R
Amikacin	≥64	R	≥64	R	–	–
Gentamicin	≥16	R	≥16	R	≥16	R
Tobramycin	≥16	R	≥16	R	≥16	R
Ciprofloxacin	≥4	R	≥4	R	≥4	R
Levofloxacin	≥8	R	4	I	4	I
Ampicillin/sulbactam	8	S	4	S	4	S
Tetracycline	–	–	14mm	I	–	–
Minocycline	–	–	25mm	S	–	–

Notes: Susceptibility testing with the Vitek2 compact system (bioMerieux, Marcy-I’Etoile, France): interpreted according to the 2018 Clinical and Laboratory Standards Institute (CLSI) criteria for non fermentative isolates.

Abbreviations: KB, Kirby-Bauer disk diffusion method; MIC, minimal inhibitory concentration; S, susceptible; R, resistant; I, intermediate.

Figure 1 The first chest CT scan of the patient when she was sent to the emergency.

Figure 2 Bacteria colony of Pandoraea species cultured on Columbia blood plate for 48 hours.

Figure 3 Wound situation of the patient before and after treatment. (A) Skin wound of the lower back; (B) skin wound of the right thigh; (C and D) Skin wound of the lower back after 2-months’ treatment.

Figure 4 The treatment timeline showed clinical manifestations, significant examination results, and related antibiotic treatments of the case.

Table 2 Case Reports Infected or Colonized with Pandoraea Species in Non-CF Patients

Author and Year	Age/Gender/Country	Clinical Records (Underlying Diseases)	Strains	Sources	Antibiotic Susceptibility Test (Method/Interpretive Susceptibility Criteria)	Antibiotic Treatment	Outcomes
Coenye 2000^Citation1	NG/Belgium	NG	P. norimbergensis	Blood	NG	NG	NG
	NG/Sweden	NG	P. norimbergensis	BALF	NG	NG	NG
Daneshvar 2001^Citation5	66 y/ F/ USA	COPD	P. apista	Blood	NG	NG	NG
	75 y/ F/ USA	NG	P. apista	BALF	NG	NG	NG
	46 y/ M/ USA	Bacteremia	P. Pnomenusa	Blood	NG	NG	NG
	NG/ F/ USA	NG	Pandoraea species	Maxillary sinus	NG	NG	NG
	76y/ M/ USA	Bacteremia	P. Pnomenusa	Blood	NG	NG	NG
	49y/ M/ USA	NG	P. Pnomenusa	Blood	NG	NG	NG
	71y /F/ USA	Pneumonia	Pandorae species	Sputum	NG	NG	NG
Stryjewski 2003^Citation9	30y/M/ USA	Sepsis, MODS (lung transplantation)	P. Pnomenusa	Blood	S: IPM, MNO R: TEP, CAZ, MEM, AMK (KB/ NG)	IPM	Dead
Falces 2016^Citation10	10m/NG./Spain	Catheter-associated bacteremia (acute lymphoblastic leukemia)	P. Pnomenusa	Blood	NG	IPM	Alive
GAO 2018^Citation18	23 days/ M/China	Bacteremia (Neonatal jaundice)	Pandorae species	Blood	S: SXT, IPM, SAM, TCY I: TZP R: PIP, C, FEP, ATM, MEM, AMK, GEN, TOB, CIP, LVX (KB/ CLSI for Pseudomonas aeruginosa)	AMP+CSL	Alive
Monzón 2018^Citation16	71y /M / Spain	Colonization of CVC (Multiple myeloma, end-stage renal disease, hypertension, and type 2 diabetes mellitus)	P. sputorum	Hemodialysis catheter	NG	Removed the CVC	Alive
Lin 2019^Citation13	44y/M /China	Pneumonia (multiple injuries and coma after a brain injury)	P. Apista	Sputum	NG	MEM (2 g IV, 8 q8h) and VAN (1 million IU IV, q12h)	Dead
Xiao 2019^Citation17	43y/M /China	Bacteremia (Allogeneic liver transplantation with immunosuppressive therapy)	P. Sputorum	Blood	S: PIPP, TZP, CRO, IPM, CIP, LVX, TCY, MNO I: AMK R: CAZ, ATM, MEM, GEN, TOB, FEP (MIC/ other non-Enterobacteriaceae)	IPM (500 mg IV, q8 h) and TZC (2g IV, q12 h)	Alive
Patil 2021^Citation14	67/M /India	Skull base osteomyelitis	P. Apista	Skull base	NG	CIP (750mg, bid)	Alive
Singh 2021^Citation15	72y/M /India	Bacteremia (ARDS, COVID-19 Positive, diabetic)	P. Apista	Blood	S: SXT, IPM, MNO R: TEP, CAZ, MEM, AM (NG/ CLSI guidelines)	IPM (1g IV, q6 h)	Alive
Bodendoerfer 2021^Citation11	37y/M /Switzerland	CLABSI, PVE (injecting drug user)	P. pnomenusa	Blood	S: SXT, TZP, FEP, IPM, CIP, LVX, TCY, MNO R: PIP, AMP, CAZ, MEM, GEN, TGC (KB/EUCAST for Pseudomonas aeruginosa)	TZP *3 weeks; continuing with SXT*3 weeks	Alive
Dlewati 2021^Citation19	69y/M /USA	VAP, ARDS (COVID-19 positive ventilation)	Pandorae species	Respiratory secretion	S: IPM, AMK, CIP, LVX, MNO I: GEN R: CAZ, FEP, ATM, MEM (MIC/ CLSI guidelines)	MEM and MIF	Dead
Cubides-Diaz2022^Citation12	55y/M /Colombia	Pneumonia (COVID-19 positive, ventilation)	P. pnomenusa	Respiratory secretion	S: SXT (KB/CLSI for Burkholderia cepacia complex) I: CIP (KB/CLSI for Pseudomonas aeruginosa)	CIP (400mg IV, bid)+SXT (240/1200 mg po, tid)*14 days	Alive
Our case	46y/F /China	Bacteremia with wound infection (multiple pelvic and rib fractures, acute traumatic brain injury, and multiple burns)	P. sputorum	Blood and wound secretion	Referring to Table 1 (MIC and KB/ CLSI for non-fermentative bacteria)	IPM (1.0q IV, 8h) + TGC (50mg IV, q12h)*14 days	Alive

Abbreviations: NG, not given; BALF, Bronchoalveolar Lavage Fluid; F, female; COPD, chronic obstructive pulmonary disease; M, male; MODS, multiple organ dysfunction syndromes; CVC, central venous catheter; IV, intravenous; ARDS, acute respiratory distress syndrome; CLABSI, central venous catheter-associated bloodstream infection; PVE, prosthetic valve endocarditis; VAP, ventilation-associated pneumonia; S, sensitive; R, resistant; I, intermediate; KB, Kirby-Bauer disk diffusion method; MIC, minimal inhibitory concentration; CLSI, Clinical and Laboratory Standards Institute; EUCAST, European Committee for Antimicrobial Susceptibility Testing; SXT, Trimethoprim/Sulfamethoxazole; PIP, Piperacillin; TZP, Piperacillin/tazobactam; CZO, Cefazolin; CXM, Cefuroxime; AMP, Ampicillin; CTL, Cefotetan; CAZ, Ceftazidime; CRO, Ceftriaxone; FEP, Cefepime; ATM, Aztreonam; IPM, Imipenem; MEM, Meropenem; AMK, Amikacin; GEN, Gentamicin; TOB, Tobramycin; CIP, Ciprofloxacin; LVX, Levofloxacin; SAM, Ampicillin/sulbactam; TCY, Tetracycline; MNO, Minocycline; TGC, Tigecycline; AMP, Ampicillin; CSL, Cefoperazone/sulbactam; VAN, Vancomycin; TZC, Ceftriaxone/tazobactam; MIF, Micafungin.

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