Volume 29, Number 11—November 2023
Synopsis
Outbreak of Pandoraea commovens Infections among Non–Cystic Fibrosis Intensive Care Patients, Germany, 2019–2021
Tassilo Kruis
, Peter Menzel, Rolf Schwarzer, Solveigh Wiesener, Felix Schoenrath, Frank Klefisch, Miriam Stegemann, and Frieder Pfäfflin
, Peter Menzel, Rolf Schwarzer, Solveigh Wiesener, Felix Schoenrath, Frank Klefisch, Miriam Stegemann, and Frieder Pfäfflin
Table 2
Clinical details for an outbreak of Pandoraea commovens among non–cystic fibrosis intensive care patients, Germany, 2019–2021.
| Case no. | Age, y/sex | Course of infection | Underlying conditions | Pandoraea-positive specimens | Antimicrobial drug therapy |
|---|---|---|---|---|---|
| 1 |
66/M |
Colonization only |
Chronic lung disease, solid tumor |
Bile |
None |
| 2 |
67/F |
Necrotizing pancreatitis with superinfection; P. commovens repeatedly detected during 4 weeks; needed mechanical ventilation, renal dialysis; and repeated endoscopic necrosectomies; discharged alive |
Hyperparathyreoidism with hypercalcemia; diabetes mellitus with chronic kidney disease |
Abdominal puncture ×2; wound swab; ascites puncture ×2 |
Meropenem |
| 3 |
59/M |
Colonization only |
Double lung transplantation due to pulmonary hypertension; immunosuppression with mycophenolate-mofetil, cyclosporin, and corticosteroids |
Wound swab |
None |
| 4 |
81/M |
Colonization only |
Congestive heart failure; status post myocardial infarction; diabetes mellitus with chronic kidney disease; moderate to severe hepatopathy |
Bronchial lavage; tracheobronchial secretion ×2 |
None |
| 5 |
77/F |
Colonization only |
Congestive heart failure; myocardial infarction; peripheral vascular disease |
Bronchial lavage; tracheobronchial secretion |
None |
| 6 |
68/F |
Colonization only |
Vertebral fracture; coronary heart disease |
Throat swab |
None |
| 7 |
45/M |
Pancreatitis after endoscopic retrograde cholangiography, acute respiratory distress syndrome, complicated intraabdominal infection with bacteremia; P. commovens repeatedly detected during 3 weeks; multiple surgeries for source control; renal dialysis; died, but death not attributable to P. commovens infection |
Gallstones |
Blood culture; intraabdominal swab ×5; intraabdominal biopsy; tracheobronchial secretion ×2 |
Imipenem, TMP/SXT |
| 8 |
71/F |
Colonization only |
Status post cardiogenic and septic shock with multiorgan failure; diabetes mellitus with chronic kidney disease; moderate to severe hepatopathy |
Bronchial lavage |
None |
| 9 |
69/M |
Ventilator-associated pneumonia after mitral valve replacement and coronary artery bypass graft; discharged alive |
Congestive heart failure |
Tracheobronchial secretion |
Imipenem |
| 10 |
69/M |
Colonization only |
Cardiomyopathy with left and right ventricular assist device; peripheral vascular disease; lymphoma |
Throat swab ×2 |
None |
| 11 |
49/F |
Unclear; died on same day as P. commovens sampling |
Cardiomyopathy, evaluated for heart transplantation |
Tracheobronchial secretion |
None |
| 12 |
75/F |
Colonization only |
Thoracic endovascular aortic repair due to aneurysm; chronic kidney disease |
Throat swab |
None |
| 13 |
59/F |
Ventilator-associated pneumonia; discharged alive |
Central nervous system diffuse large B cell lymphoma; neutropenic sepsis after methotrexate, cytarabine, thiotepa, and rituximab |
Tracheobronchial secretion |
Meropenem |
| 14 |
60/M |
Ventilator-associated pneumonia; discharged alive |
Congestive heart failure; cerebrovascular disease; peptic ulcer disease; solid tumor |
Tracheobronchial secretion |
Imipenem |
| 15 |
67/F |
Septic shock, ventilator-associated pneumonia, renal dialysis; died, but likely not attributable to P. commovens infection |
Secondary acute myeloid leukemia, status post allogeneic stem cell transplantation; immunosuppression with cyclosporine A; right heart failure; pulmonary hypertension |
Tracheobronchial secretion |
Imipenem |
| 16 |
62/M |
Ventilator-associated pneumonia; discharged alive |
Congestive heart failure, status post myocardial infarction; chronic lung disease |
Tracheobronchial secretion ×3 |
Imipenem |
| 17 |
75/F |
Ventilator-associated pneumonia; died, but likely not attributable to P. commovens infection |
Congestive heart failure; chronic kidney disease |
Tracheobronchial secretion; throat swab |
Imipenem |
| 18 |
69/F |
Colonization only |
Congestive heart failure; cerebrovascular disease; solid tumor |
Tracheobronchial secretion |
None |
| 19 |
67/M |
Colonization only |
Congestive heart failure; chronic lung disease; diabetes mellitus with chronic kidney disease; moderate to severe hepatopathy |
Tracheobronchial secretion |
None |
| 20 |
78/F |
ND |
ND |
Throat swab |
ND |
| 21 |
63/F |
Colonization only |
Congestive heart failure; chronic lung disease; chronic kidney disease |
Tracheobronchial secretion |
None |
| 22 |
62/M |
Ventilator-associated pneumonia after myocardial infarction; discharged alive |
Congestive heart failure; peripheral artery and cerebrovascular disease; chronic lung disease; chronic kidney disease |
Tracheobronchial secretion |
Imipenem |
| 23 |
63/M |
Colonization only |
Congestive heart failure; stroke related to atrial fibrillation; chronic kidney disease |
Tracheobronchial secretion |
ND |
| 24 | 55/M | Hospital-acquired pneumonia, mediastinitis, neutropenic sepsis; died, but likely not attributable to P. commovens infection | Infected aortic prosthesis; secondary acute myeloid leukemia; chronic myelomonocytic leukemia | Sputum | Imipenem |
*Whole-genome sequencing was performed on isolates from patients 7, 9–11, and 14–24. However, due to the local and temporal relationships, identical colony morphology, and antibiotic susceptibilities, we assumed that the correct species was P. commovens in all patients reported here. ND, no data; TMP/SXT, trimethoprim/sulfamethoxazole.
Page created: October 03, 2023
Page updated: October 23, 2023
Page reviewed: October 23, 2023
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