Bordetella trematum infection: case report and review of previous cases

Abstract

Background Bordetella trematum is an infrequent Gram-negative coccobacillus, with a reservoir, pathogenesis, a life cycle and a virulence level which has been poorly elucidated and understood. Related information is scarce due to the low frequency of isolates, so it is important to add data to the literature about this microorganism. Case presentation We report a case of a 74-year-old female, who was referred to the hospital, presenting with ulcer and necrosis in both legs. Therapy with piperacillin-tazobactam was started and peripheral artery revascularization was performed. During the surgery, a tissue fragment was collected, where Bordetella trematum , Stenotrophomonas maltophilia, and Enterococcus faecalis were isolated. After surgery, the intubated patient was transferred to the intensive care unit (ICU), using vasoactive drugs through a central venous catheter. Piperacillin-tazobactam was replaced by meropenem, with vancomycin prescribed for 14 days. Four days later, levofloxacin was added for 24 days, aiming at the isolation of S. maltophilia from the ulcer tissue. The necrotic ulcers evolved without further complications, and the patient’s clinical condition improved, leading to temporary withdrawal of vasoactive drugs and extubation. Ultimately, however, the patient’s general condition worsened, and she died 58 days after hospital admission. Conclusions Despite being a rare finding, B. trematum is typically associated with the clinical manifestation of disorders that predispose to ulcer development, which can be infected by microorganisms. The combination of antibiotic therapy and surgical debridement plays a key role in preventing systemic infections. Monitoring the appearance of new cases of B. trematum is essential, since it can be an emerging microorganism. Isolating and defining the clinical relevance of unusual bacteria yields a more accurate perspective in the development of new diagnostic tools and allows for assessment of proper antimicrobial therapy.

Erysipelas of the right arm due to Bordetella trematum: a case report

“…The interpretation of a positive blood culture of B. trematum remains difficult and, in the context of sepsis, should prompt a suitable antibiotic therapy. Thanks to new diagnostic tools such as MALDI-TOF and molecular biology, it is now easier to identify [7][8][9][10][11][12], though there are still mistakes in its recognition.…”

“…The choice of ceftazidime in our case was made according to the sensitivity testing. Despite the piperacillin-tazobactam sensitivity in vitro in all precedent case reports, patients died despite piperacillin-tazobactam therapy in two of them [12,13] and had an unfavorable outcome in another one [11], whereas, in the case of Hernandez-Porto et al, the patient had also renal failure and the treatment was a success. Given these discordant results, the place of piperacillin-tazobactam in the therapeutic strategy for the treatment of B. trematum infections should be reconsidered.…”

“…Bordetella trematum infections have been identified in 14 case reports in the literature (12 are summarized in Table 1 ). Most cases were found in diabetic patients, particularly from ulcers and chronic ear infections [ 1 , 4 , 7 , 9 , 12 ]. Several authors consider that this germ is not very pathogenic and that its natural evolution does not require specific antibiotherapy [ 4 , 7 ].…”

The occurrence of Salmonella, extended‐spectrum β‐lactamase producing Escherichia coli and carbapenem resistant non‐fermenting Gram‐negative bacteria in a backyard poultry flock environment

“…In this study, one isolate each of B. trematum, H. alvei, O. intermedium, R. ornithinolytica and S. maltophilia was isolated (Table 1). All these bacteria are recognized opportunistic pathogens mostly associated with hospital-acquired infections in immunocompromised individuals (Aujoulat, Romano-Bertrand, Masnou, Marchandin, & Jumas-Bilak, 2014;Brooke, 2012;Ramos & Dámaso, 2000;Sękowska, 2017;Seng et al, 2016;Trifonova & Strateva, 2019;y Castro et al, 2019).…”

Detection and Characterization of Clinical Bordetella trematum Isolates from Chronic Wounds

“…The most important ones in this regard are Pseudomonas aeruginosa , Acinetobacter baumannii, and Stenotrophomonas maltophilia . A recent literature review reveals the clinical significance of B. trematum to still be a matter of debate as the little information available on this pathogen left authors largely uncertain as to whether therapy was necessary or superfluous in the respective cases [ 2 , 3 , 4 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Previously documented cases have mainly been isolated from ulcers and soft tissue infections, even though occasional cases of bacteremia have been described [ 6 , 7 ].…”