Letter to the Editor
Hemodialysis catheter colonised by Pandoraea spotorum
Colonización de catéter tunelizado para hemodiálisis por Pandoraea spotorum
Tania Monzón
, Francisco Valga, Jorge Reichert, Celia López
Corresponding author
Centros de hemodiálisis AVERICUM SL, Departamento de Hemodiálisis, Las Palmas de Gran Canaria, Spain
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=> "Hemodialysis catheter colonised by <span class="elsevierStyleItalic">Pandoraea spotorum</span>" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "662" "paginaFinal" => "664" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Tania Monzón, Francisco Valga, Jorge Reichert, Celia López" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Tania" "apellidos" => "Monzón" "email" => array:1 [ 0 => "taniarmv@msn.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "Francisco" "apellidos" => "Valga" ] 2 => array:2 [ "nombre" => "Jorge" "apellidos" => "Reichert" ] 3 => array:2 [ "nombre" => "Celia" "apellidos" => "López" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Centros de hemodiálisis AVERICUM SL, Departamento de Hemodiálisis, Las Palmas de Gran Canaria, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Colonización de catéter tunelizado para hemodiálisis por <span class="elsevierStyleItalic">Pandoraea spotorum</span>" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Tunnelled catheters are used daily in Nephrology clinical practice, generally in patients who do not have another vascular access (VA) for hemodialysis such as arteriovenous fistula or vascular prosthesis. It is widely known that the use of central venous catheters (CVC) increases the comorbidity of patients considerably; especially due to infections and risk of bacteraemia.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Colonisation of tunnelled catheters without yet causing bacteraemia is also a source of comorbidity and significant medical expense, which should be kept in mind.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Pandoraea</span> genus is considered an emerging pathogen, especially in patients with cystic fibrosis, but there are little data about outcomes of patients colonised with these organisms.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We present the case of a 79-year-old male patient with arterial hypertension, diabetes mellitus type 2, atrial fibrillation, and terminal chronic kidney disease secondary to IgA kappa multiple myeloma, diagnosed in March 2013, treated with bortezomib and dexamethasone, and currently in remission but with a need for renal replacement therapy with haemodialysis.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient has a right jugular CVC that, since instauration of chronic haemodialysis has had numerous infections located in the vascular access output hole (<span class="elsevierStyleItalic">Escherichia coli, Stenotrophomonas maltophilia</span>, <span class="elsevierStyleItalic">Acinetobacter baumannii</span>, <span class="elsevierStyleItalic">Staphylococcus epidermidis</span>), treated with topical and systemic antibiotic therapy depending on the antibiogram. These infections were identified in samples drawn with local symptoms (reddening, discharge, and pain) as well as in the respective post-treatment control cultures.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The last colonisation of the CVC output hole was by <span class="elsevierStyleItalic">Pandoraea sputorum</span> (<span class="elsevierStyleItalic">P. sputorum</span>). Therefore, given his infection history and after information about the isolated bacteria, it was decided to remove the CVC, create an internal AVF, and insert a new CVC in a femoral location while awaiting maturation of the internal AVF.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient progressed satisfactorily, at all times remaining afebrile, asymptomatic, with adequate analytical parameters, and with no new episodes of colonisation by said microorganism or other bacteria.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The <span class="elsevierStyleItalic">Pandoraea</span> genus is a gram-negative, obligate aerobic, non-glucose-fermenting bacillus, which is motile thanks to the presence of a flagellum.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">1</span></a> The <span class="elsevierStyleItalic">Pandoraea</span> genus arises from a re-examination of the species contained in the <span class="elsevierStyleItalic">Burkholderia cepacia</span> complex; it contains 9 species, of which only 5 are named: <span class="elsevierStyleItalic">Pandoraea apista</span>, <span class="elsevierStyleItalic">Pandoraea pulmonicola</span>, <span class="elsevierStyleItalic">Pandoraea pnomenusa</span>, <span class="elsevierStyleItalic">P. sputorum</span> and <span class="elsevierStyleItalic">Pandoraea norimbergensis.</span><a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">2</span></a> The species-level identification of this new genus is complex, since they often present phenotypically similar patterns to other bacterial species. <span class="elsevierStyleItalic">Pandoraea</span> is a rare pathogen isolated in patients with septicaemia and chronic lung diseases, specifically cystic fibrosis.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2–4</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">They are considered multidrug-resistant emerging pathogens and are not well known, particularly in terms of natural resistance, acquired resistance mechanisms and prognosis impact of the disease and lung function. They are nosocomial pathogens associated with equipment, ventilation systems or contaminated disinfectants.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">5</span></a> They have also been found in food, water, and mud.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">6</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Antibiotic therapy for infections caused by species of the <span class="elsevierStyleItalic">Pandoraea</span> genus is complex since it has been shown to be active against numerous antibiotics of the ampicillin, cefazolin, broad-spectrum cephalosporins, aztreonam, piperacillin and aminoglycoside types. Its response is variable to quinolones, sulfamethoxazole/trimethoprim, colistin, and carbapenems.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">2,4,7,8</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">P. sputorum</span> specifically has been previously described in a few cases of cystic fibrosis patients from Spain, Australia, Argentina, France, and the United States, emphasising the need for more clinical data for better knowledge about its pathogenicity. This is probably due to the difficulty in correctly identifying and differentiating the species in this genus.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">9</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">This is a case of an immunosuppressed patient susceptible to infection or colonisation by opportunistic bacteria. The repeated use of topical and systemic antibiotics can also cause selection of microorganisms, fostering these types of rare infections. Therefore, we must select and evaluate the use of prolonged antibiotic treatments and increase the care of CVCs. Another hypothesis is the possible asymptomatic colonisation of the respiratory tract by <span class="elsevierStyleItalic">Pandoraea</span> in patients with immunodeficiencies, as we have already mentioned. We do not know what the role of this germ may be on lung function in patients with chronic bronchopathies and their invasive potential in bacteraemia.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Monzón T, Valga F, Reichert J, López C, Colonización de catéter tunelizado para hemodiálisis por <span class="elsevierStyleItalic">Pandoraea spotorum</span>. 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Rafferty" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:4 [ "edicion" => "3.ª ed" "fecha" => "2004" "editorial" => "South Eastern Area Laboratory Services" "editorialLocalizacion" => "Randwick, NSW, Australia" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0090" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Descripción de <span class="elsevierStyleItalic">Pandoraea</span> gen. nov. Con <span class="elsevierStyleItalic">Pandoraea apista</span> sp. Nov., <span class="elsevierStyleItalic">Pandoraea pulmonicola</span> sp. Nov., <span class="elsevierStyleItalic">Pandoraea pnomenusa</span> sp. Nov., <span class="elsevierStyleItalic">Pandoraea sputorum</span> sp. nov. <span class="elsevierStyleItalic">Y el</span> peine <span class="elsevierStyleItalic">Pandoraea norimbergensis</span> nov" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "T. Coenye" 1 => "E. Falsen" 2 => "B. Hoste" 3 => "M. Ohlen" 4 => "J. Goris" 5 => "J.R. Govan" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1099/00207713-50-2-887" "Revista" => array:6 [ "tituloSerie" => "Int J Syst Evol Microbiol" "fecha" => "2000" "volumen" => "50" "paginaInicial" => "887" "paginaFinal" => "899" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10758901" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003800000006/v1_201812140610/S2013251418300920/v1_201812140610/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003800000006/v1_201812140610/S2013251418300920/v1_201812140610/en/main.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2013251418300920?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 8 | 15 |
| 2024 October | 44 | 40 | 84 |
| 2024 September | 51 | 37 | 88 |
| 2024 August | 58 | 63 | 121 |
| 2024 July | 41 | 28 | 69 |
| 2024 June | 63 | 44 | 107 |
| 2024 May | 55 | 37 | 92 |
| 2024 April | 57 | 31 | 88 |
| 2024 March | 43 | 30 | 73 |
| 2024 February | 38 | 39 | 77 |
| 2024 January | 33 | 30 | 63 |
| 2023 December | 30 | 30 | 60 |
| 2023 November | 77 | 36 | 113 |
| 2023 October | 63 | 37 | 100 |
| 2023 September | 46 | 28 | 74 |
| 2023 August | 66 | 37 | 103 |
| 2023 July | 51 | 39 | 90 |
| 2023 June | 95 | 28 | 123 |
| 2023 May | 90 | 33 | 123 |
| 2023 April | 51 | 17 | 68 |
| 2023 March | 59 | 20 | 79 |
| 2023 February | 46 | 25 | 71 |
| 2023 January | 56 | 30 | 86 |
| 2022 December | 53 | 34 | 87 |
| 2022 November | 58 | 34 | 92 |
| 2022 October | 69 | 43 | 112 |
| 2022 September | 52 | 33 | 85 |
| 2022 August | 65 | 44 | 109 |
| 2022 July | 46 | 52 | 98 |
| 2022 June | 51 | 45 | 96 |
| 2022 May | 60 | 29 | 89 |
| 2022 April | 53 | 70 | 123 |
| 2022 March | 53 | 51 | 104 |
| 2022 February | 47 | 45 | 92 |
| 2022 January | 49 | 37 | 86 |
| 2021 December | 77 | 38 | 115 |
| 2021 November | 63 | 38 | 101 |
| 2021 October | 90 | 41 | 131 |
| 2021 September | 57 | 30 | 87 |
| 2021 August | 57 | 49 | 106 |
| 2021 July | 75 | 31 | 106 |
| 2021 June | 58 | 36 | 94 |
| 2021 May | 70 | 68 | 138 |
| 2021 April | 127 | 51 | 178 |
| 2021 March | 99 | 45 | 144 |
| 2021 February | 43 | 40 | 83 |
| 2021 January | 63 | 25 | 88 |
| 2020 December | 41 | 21 | 62 |
| 2020 November | 43 | 17 | 60 |
| 2020 October | 31 | 20 | 51 |
| 2020 September | 53 | 20 | 73 |
| 2020 August | 57 | 24 | 81 |
| 2020 July | 49 | 19 | 68 |
| 2020 June | 57 | 18 | 75 |
| 2020 May | 44 | 14 | 58 |
| 2020 April | 57 | 26 | 83 |
| 2020 March | 60 | 15 | 75 |
| 2020 February | 42 | 21 | 63 |
| 2020 January | 69 | 28 | 97 |
| 2019 December | 51 | 25 | 76 |
| 2019 November | 55 | 23 | 78 |
| 2019 October | 29 | 16 | 45 |
| 2019 September | 59 | 27 | 86 |
| 2019 August | 26 | 25 | 51 |
| 2019 July | 32 | 30 | 62 |
| 2019 June | 23 | 36 | 59 |
| 2019 May | 42 | 40 | 82 |
| 2019 April | 71 | 54 | 125 |
| 2019 March | 36 | 28 | 64 |
| 2019 February | 26 | 23 | 49 |
| 2019 January | 35 | 40 | 75 |
| 2018 December | 86 | 58 | 144 |
| 2018 November | 118 | 21 | 139 |
| 2018 October | 35 | 10 | 45 |
| 2018 September | 59 | 22 | 81 |
| 2018 August | 45 | 13 | 58 |
| 2018 July | 15 | 1 | 16 |
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