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Meropenem-Resistant Pandoraea Pneumonia in a Critically Ill Patient With COVID-19
Mohammad M Dlewati1, Pyi Phyo Aung1, Kyeeun Park1
1Internal Medicine, Memorial Healthcare System, Hollywood, USA.
Abstract:
Among patients infected with respiratory viruses, primary coinfection or secondary bacterial pneumonia is common in the severely ill. Pandoraea are multi-drug resistant gram-negative bacilli that have been newly classified in the past 20 years. We present the first reported case of Pandoraea co-infection with SARS-CoV-2 infection. A critically ill gentleman with COVID-19 in acute respiratory distress syndrome (ARDS) requiring mechanical ventilation developed ventilator-associated bacterial pneumonia (VAP). Initial sputum cultures grew Pandoraea species, with subsequent cultures growing P. aeruginosa, and K. pneumoniae as well. The patient failed to improve despite several antibiotic regimens including meropenem. Send-out reference laboratory testing of the Pandoraea species showed susceptibility to amikacin, ciprofloxacin, levofloxacin, imipenem, and minocycline, but resistance to aztreonam, cefepime, ceftazidime, and meropenem. The patient had deteriorated to multi-organ failure by the time minocycline was initiated, and his family had transitioned him into hospice care. Carbapenems are vital agents in the treatment of VAP. Pandoraea species are often resistant to meropenem but often retain in-vitro sensitivity to imipenem-cilastin. Although mainly isolated from respiratory specimens of patients with cystic fibrosis, cases of infection in non-cystic fibrosis patients have been increasingly recognized. The presentation of this case aims to increase awareness of the high drug resistance of this rising species and reduce delays in treatment, especially in COVID-19 coinfection.
Insights
This case report details the first instance of Pandoraea co-infection in a patient with COVID-19 and acute respiratory distress syndrome. It highlights the critical need for prompt identification and appropriate antibiotic selection for drug-resistant bacterial pneumonia in critically ill patients.
Area of Science:
- Infectious Diseases
- Microbiology
- Critical Care Medicine
Background:
- Bacterial pneumonia, particularly ventilator-associated bacterial pneumonia (VAP), frequently complicates severe respiratory viral infections like COVID-19.
- Pandoraea, a genus of multi-drug resistant gram-negative bacilli, has emerged as a significant pathogen in recent decades.
- Early and accurate diagnosis of bacterial coinfections is crucial for effective management of critically ill patients with viral respiratory illnesses.
Observation:
- A critically ill COVID-19 patient with acute respiratory distress syndrome (ARDS) developed VAP with a polymicrobial infection including Pandoraea species.
- Initial sputum cultures revealed Pandoraea, followed by Pseudomonas aeruginosa and Klebsiella pneumoniae.
- The patient demonstrated resistance to meropenem and other antibiotics, failing to improve despite multiple treatment regimens.
Findings:
- Reference laboratory testing identified Pandoraea species with susceptibility to amikacin, ciprofloxacin, levofloxacin, imipenem, and minocycline, but resistance to aztreonam, cefepime, ceftazidime, and meropenem.
- Despite susceptibility to certain agents, the patient's condition deteriorated to multi-organ failure.
- Pandoraea species often exhibit resistance to carbapenems like meropenem but may remain sensitive to imipenem-cilastin.
Implications:
- This case underscores the rising threat of drug-resistant Pandoraea infections, especially in immunocompromised or critically ill patients.
- Prompt recognition of Pandoraea co-infection in COVID-19 patients is vital to avoid treatment delays and improve outcomes.
- Increased awareness of Pandoraea's drug resistance patterns is necessary for clinicians managing VAP in non-cystic fibrosis patients.
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