Pandoraea pnomenusa Superinfection in a Patient with SARS-CoV-2 Pneumonia: First Case in the Literature

Díaz, Diego Alejandro Cubides; Angulo, Natalia Muñoz; Arsanios, Daniel Augusto Martin; Monroy, Ana Lucia Ovalle; Perdomo-Rodriguez, Daniel Ricardo; Del-Portillo, Maria Paula

doi:10.3390/idr14020025

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…Gram-negative microorganisms are associated with coinfections in patients with COVID-19 (Povoa et al 2020 ; Sehgal et al 2021 ; Singh et al 2021 ; Cubides-Diaz et al 2022 ). Pandoraea species, which are gram-negative bacteria, can cause bacteremia and lung function decline (Lin et al 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…MDR organisms have emerged not only in the hospital environment but also in community settings, suggesting that reservoirs of antibiotic-resistant bacteria are present around hospitals (Youlden et al 2022 ). Pandoraea species is a newly emerging multidrug-resistant pathogen usually isolated from a variety of clinical samples (See-Too et al 2019 ; Gawalkar et al 2021 ; Singh et al 2021 ; Cubides-Diaz et al 2022 ; Ramos Oliveira et al 2023 ) with antibiotic resistance (Schneider et al 2006 ). In this study, we isolated the MDR gram-negative strain P. pnomenusa M202 from hospital sewage.…”

Section: Introductionmentioning

confidence: 99%

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An efflux pump in genomic island GI-M202a mediates the transfer of polymyxin B resistance in Pandoraea pnomenusa M202

Gao

Wang³

et al. 2023

Int Microbiol

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Background Polymyxin B is considered a last-line therapeutic option against multidrug-resistant gram-negative bacteria, especially in COVID-19 coinfections or other serious infections. However, the risk of antimicrobial resistance and its spread to the environment should be brought to the forefront. Methods Pandoraea pnomenusa M202 was isolated under selection with 8 mg/L polymyxin B from hospital sewage and then was sequenced by the PacBio RS II and Illumina HiSeq 4000 platforms. Mating experiments were performed to evaluate the transfer of the major facilitator superfamily (MFS) transporter in genomic islands (GIs) to Escherichia coli 25DN. The recombinant E. coli strain Mrc-3 harboring MFS transporter encoding gene FKQ53_RS21695 was also constructed. The influence of efflux pump inhibitors (EPIs) on MICs was determined. The mechanism of polymyxin B excretion mediated by FKQ53_RS21695 was investigated by Discovery Studio 2.0 based on homology modeling. Results The MIC of polymyxin B for the multidrug-resistant bacterial strain P. pnomenusa M202, isolated from hospital sewage, was 96 mg/L. GI-M202a, harboring an MFS transporter-encoding gene and conjugative transfer protein-encoding genes of the type IV secretion system, was identified in P. pnomenusa M202. The mating experiment between M202 and E. coli 25DN reflected the transferability of polymyxin B resistance via GI-M202a. EPI and heterogeneous expression assays also suggested that the MFS transporter gene FKQ53_RS21695 in GI-M202a was responsible for polymyxin B resistance. Molecular docking revealed that the polymyxin B fatty acyl group inserts into the hydrophobic region of the transmembrane core with Pi-alkyl and unfavorable bump interactions, and then polymyxin B rotates around Tyr43 to externally display the peptide group during the efflux process, accompanied by an inward-to-outward conformational change in the MFS transporter. Additionally, verapamil and CCCP exhibited significant inhibition via competition for binding sites. Conclusions These findings demonstrated that GI-M202a along with the MFS transporter FKQ53_RS21695 in P. pnomenusa M202 could mediate the transmission of polymyxin B resistance.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An efflux pump in genomic island GI-M202a mediates the transfer of polymyxin B resistance in Pandoraea pnomenusa M202

Gao

Wang³

et al. 2023

Int Microbiol

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“…Gram-negative microorganisms were reported during co-infections in patients with COVID-19 [34][35][36][37].…”

Section: Discussionmentioning

confidence: 99%

“…Pandoraea species, which belongs to Gram-negative bacteria, can cause bacteremia and lung function decline [38]. Pandoraea pnomenusa superinfection in a patient with COVID-19 pneumonia was found in 2022, Colombia [35]. While, Pandoraea spp.…”

Section: Discussionmentioning

confidence: 99%

Efflux pump in genomic island GI-M202a mediates transfer of Polymyxin B resistance in Pandoraea pnomenusa M202

Gao

Li²,

Wang³

et al. 2023

Preprint

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Background Polymyxin B was thought to be last-line therapeutic options against multidrug-resistant Gram-negative bacteria, especially in COVID-19 co-infections or other serious infections. The risk of antimicrobial resistance and its spread to the environment should be brought to the forefront. Methods P. pnomenusa M202 was isolated under selection with 8 mg/L polymyxin B from hospital sewage. The genome of M202 was sequenced by PacBio RS II and Illumina HiSeq 4000 platforms. MFS transporter recombinant E. coli strain Mrc-3 was constructed by transferring encoding gene FKQ53_RS21695, a gene in Genomic islands (GIs) of M202, to E. coli 25DN. Mating experiments were performed to evaluate transfer of MFS transporter to Escherichia coli 25DN. And influences of efflux pump inhibitors on MICs were determined. The mechanism of polymyxin B excretion mediated by FKQ53_RS21695 was investigated by Discovery Studio 2.0 based on its homologous model. Results MICs of multidrug-resistant bacterial strain P. pnomenusa M202, isolated from hospital sewage, for polymyxin B is 96 mg/L. Genomic Island GI-M202a with major facilitator superfamily (MFS) transporter encoding gene and conjugative transfer proteins encoding genes of type IV secretion system was identified in strain M202. The mating experiment between M202 and Escherichia coli 25DN reflected the transferability of polymyxin B resistant GI-M202a. Efflux pump inhibitor and heterogeneous expression assays also suggested that MFS transporter gene FKQ53_RS21695 in GI-M202a was responsible to polymyxin B resistance. Molecular docking revealed that polymyxin B fatty acyl group insert into hydrophobic region of transmembrane core with Pi-alkyl and unfavorable bump interactions, and then polymyxin B turns over around Tyr43 to left the peptide group to outside during efflux process, accompanies with conformation change of MFS transporter from inward to outward. Additionally, verapamil and CCCP demonstrated significant inhibition by competing binding sites. Conclusions These findings demonstrated that GI-M202a along with MFS transporter FKQ53_RS21695 in P. pnomenusa M202 could mediate the transmission of polymyxin B resistances.

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“…However, the susceptibility results vary between different stains. Some of the isolates were reported to be sensitive to trimethoprim-sulphamethoxazole, 11 , 12 , 15 , 18 minocycline, 17 , 19 piperacillin/tazobactam, 11 , 17 ampicillin/sulbactam, 18 ciprofloxacin, 11 , 17 , 19 and tetracycline. 11 , 17 , 18 Interestingly, almost all of the Pandoraea species were reported to be resistant to meropenem but sensitive to imipenem, which was the opposite of most Gram-negative non-fermenting bacteria (see Table 2 ).…”

Section: Discussionmentioning

confidence: 99%

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

Ma¹,

Zou²,

Lin³

et al. 2022

IDR

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Pandoraea sputorum ( P. sputorum ) infection is of great concern as these gram-negative bacillus species are multidrug-resistant and usually isolated from the patients’ respiratory tract suffering from cystic fibrosis (CF). A few cases of infection have also been reported in non-CF patients due to its rare pathogenic nature with unclear and overlapping clinical, biochemical, and microbiological characteristics with other species. Here, we report an unusual case of a 46-year-old non-CF female, who presented with multiple pelvic fractures, acute traumatic brain injury, multiple rib fractures, and multiple burns (18% of the total body surface area, II°) by the collapse of a brick kiln, suffered from P. sputorum sepsis due to wound infection. Pandoraea species were isolated both from her blood and wound secretion. Antibiotic susceptibility testing indicated susceptibility to imipenem, tetracyclines, sulfamethoxazole, and ampicillin/sulbactam but resistance to meropenem, quinolones, aminoglycosides, and other beta-lactams. 16S ribosomal RNA (rRNA) PCR assays and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) were used to confirm the bacteria as P. sputorum . After effective anti-infection of intravenous antibiotics (imipenem 1.0 Q8H with tigecycline 50 mg Q12H for 14 days), wound care, and other comprehensive treatment for two months, the patient improved and was discharged from the hospital eventually. After reviewing the literature, we observed that the susceptibility results of Pandoraea species were often multidrug-resistant and had a unique pattern of being resistant to meropenem but sensitive to imipenem. Biofilm formation, carbapenemase production, and unique gene procession differed from the environmental isolates could help explain its resistance. This case report highlights the potential virulence of Pandoraea species as a pathogen in patients with no underlying disease. Although they are often multi-resistant, imipenem can be a preferred treatment for Pandoraea species in the earliest identification steps.

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Pandoraea pnomenusa Superinfection in a Patient with SARS-CoV-2 Pneumonia: First Case in the Literature

Cited by 6 publications

References 19 publications

An efflux pump in genomic island GI-M202a mediates the transfer of polymyxin B resistance in Pandoraea pnomenusa M202

An efflux pump in genomic island GI-M202a mediates the transfer of polymyxin B resistance in Pandoraea pnomenusa M202

Efflux pump in genomic island GI-M202a mediates transfer of Polymyxin B resistance in Pandoraea pnomenusa M202

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

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