Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient
Abstract Background Pandoraea species are multidrug-resistant glucose-nonfermenting gram-negative bacilli that are usually isolated from patients with cystic fibrosis (CF) and from water and soil. Reports of diseases, including bloodstream infections, caused by Pandoraea spp. in non-CF patients are...
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| Format: | Article |
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BMC
2022-06-01
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| Series: | BMC Infectious Diseases |
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| Online Access: | https://doi.org/10.1186/s12879-022-07514-z |
| _version_ | 1818212046589657088 |
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| author | Naoya Itoh Nana Akazawa Yuichi Ishibana Toshiki Masuishi Akinobu Nakata Hiromi Murakami |
| author_facet | Naoya Itoh Nana Akazawa Yuichi Ishibana Toshiki Masuishi Akinobu Nakata Hiromi Murakami |
| author_sort | Naoya Itoh |
| collection | DOAJ |
| description | Abstract Background Pandoraea species are multidrug-resistant glucose-nonfermenting gram-negative bacilli that are usually isolated from patients with cystic fibrosis (CF) and from water and soil. Reports of diseases, including bloodstream infections, caused by Pandoraea spp. in non-CF patients are rare, and the clinical and microbiological characteristics are unclear. The identification of Pandorea spp. is limited by conventional microbiological methods and may be misidentified as other species owing to overlapping biochemical profiles. Here, we report the first case of obstructive cholangitis with bacteremia caused by Pandoraea apista in a patient with advanced colorectal cancer. A 61-year-old man with advanced colorectal cancer who underwent right nephrectomy for renal cell carcinoma 4 years earlier with well-controlled diabetes mellitus was admitted to our hospital with fever for 2 days. The last chemotherapy (regorafenib) was administered approximately 3 weeks ago, and an endoscopic ultrasound-guided hepaticogastrostomy was performed 2 weeks ago under hospitalization for obstructive jaundice. Two days prior, he presented with fever with chills. He was treated with piperacillin-tazobactam for obstructive cholangitis and showed improvement but subsequently presented with exacerbation. Bacterial isolates from the blood and bile samples were identified as P. apista using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S ribosomal RNA sequencing. Based on the susceptibility results of the isolates, he was successfully treated with oral trimethoprim-sulfamethoxazole 160 mg/800 mg/day for 14 days for P. apista infection. Conclusions Pandoraea species are often misidentified. Therefore, multiple approaches should be used to identify them, and decisions regarding antimicrobial treatment should be based on actual in vitro susceptibility. Only seven cases of Pandoraea spp. bloodstream infections have been reported, and we report the first case of cholangitis with bacteremia. |
| first_indexed | 2024-12-12T05:42:10Z |
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| id | doaj.art-1d7b1a5fce794f90a5cddcdd26859e76 |
| institution | Directory Open Access Journal |
| issn | 1471-2334 |
| language | English |
| last_indexed | 2024-12-12T05:42:10Z |
| publishDate | 2022-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Infectious Diseases |
| spelling | doaj.art-1d7b1a5fce794f90a5cddcdd26859e762022-12-22T00:35:52ZengBMCBMC Infectious Diseases1471-23342022-06-012211710.1186/s12879-022-07514-zClinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patientNaoya Itoh0Nana Akazawa1Yuichi Ishibana2Toshiki Masuishi3Akinobu Nakata4Hiromi Murakami5Division of Infectious Diseases, Aichi Cancer Center HospitalDivision of Infectious Diseases, Aichi Cancer Center HospitalDivision of Infectious Diseases, Aichi Cancer Center HospitalDepartment of Clinical Oncology, Aichi Cancer Center HospitalDepartment of Clinical Oncology, Aichi Cancer Center HospitalDivision of Infectious Diseases, Aichi Cancer Center HospitalAbstract Background Pandoraea species are multidrug-resistant glucose-nonfermenting gram-negative bacilli that are usually isolated from patients with cystic fibrosis (CF) and from water and soil. Reports of diseases, including bloodstream infections, caused by Pandoraea spp. in non-CF patients are rare, and the clinical and microbiological characteristics are unclear. The identification of Pandorea spp. is limited by conventional microbiological methods and may be misidentified as other species owing to overlapping biochemical profiles. Here, we report the first case of obstructive cholangitis with bacteremia caused by Pandoraea apista in a patient with advanced colorectal cancer. A 61-year-old man with advanced colorectal cancer who underwent right nephrectomy for renal cell carcinoma 4 years earlier with well-controlled diabetes mellitus was admitted to our hospital with fever for 2 days. The last chemotherapy (regorafenib) was administered approximately 3 weeks ago, and an endoscopic ultrasound-guided hepaticogastrostomy was performed 2 weeks ago under hospitalization for obstructive jaundice. Two days prior, he presented with fever with chills. He was treated with piperacillin-tazobactam for obstructive cholangitis and showed improvement but subsequently presented with exacerbation. Bacterial isolates from the blood and bile samples were identified as P. apista using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S ribosomal RNA sequencing. Based on the susceptibility results of the isolates, he was successfully treated with oral trimethoprim-sulfamethoxazole 160 mg/800 mg/day for 14 days for P. apista infection. Conclusions Pandoraea species are often misidentified. Therefore, multiple approaches should be used to identify them, and decisions regarding antimicrobial treatment should be based on actual in vitro susceptibility. Only seven cases of Pandoraea spp. bloodstream infections have been reported, and we report the first case of cholangitis with bacteremia.https://doi.org/10.1186/s12879-022-07514-zPandoraea apistaMatrix-assisted laser desorption/ionization time-of-flight mass spectrometryRibosomal RNA sequencingCholangitisBloodstream infectionBacteremia |
| spellingShingle | Naoya Itoh Nana Akazawa Yuichi Ishibana Toshiki Masuishi Akinobu Nakata Hiromi Murakami Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient BMC Infectious Diseases Pandoraea apista Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry Ribosomal RNA sequencing Cholangitis Bloodstream infection Bacteremia |
| title | Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient |
| title_full | Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient |
| title_fullStr | Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient |
| title_full_unstemmed | Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient |
| title_short | Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient |
| title_sort | clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by pandoraea apista identified by maldi tof mass spectrometry and ribosomal rna sequencing in a cancer patient |
| topic | Pandoraea apista Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry Ribosomal RNA sequencing Cholangitis Bloodstream infection Bacteremia |
| url | https://doi.org/10.1186/s12879-022-07514-z |
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