Journal Information
Vol. 38. Issue. 6.November - December 2018
Pages 573-680
Vol. 38. Issue. 6.November - December 2018
Pages 573-680
Letter to the Editor
DOI: 10.1016/j.nefroe.2018.06.013
Open Access
Hemodialysis catheter colonised by Pandoraea spotorum
Colonización de catéter tunelizado para hemodiálisis por Pandoraea spotorum
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Tania Monzón
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taniarmv@msn.com

Corresponding author.
, Francisco Valga, Jorge Reichert, Celia López
Centros de hemodiálisis AVERICUM SL, Departamento de Hemodiálisis, Las Palmas de Gran Canaria, Spain
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Dear Editor,

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.

Colonisation of tunnelled catheters without yet causing bacteraemia is also a source of comorbidity and significant medical expense, which should be kept in mind.

The Pandoraea 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.

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.

The patient has a right jugular CVC that, since instauration of chronic haemodialysis has had numerous infections located in the vascular access output hole (Escherichia coli, Stenotrophomonas maltophilia, Acinetobacter baumannii, Staphylococcus epidermidis), 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.

The last colonisation of the CVC output hole was by Pandoraea sputorum (P. sputorum). 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.

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.

The Pandoraea genus is a gram-negative, obligate aerobic, non-glucose-fermenting bacillus, which is motile thanks to the presence of a flagellum.1 The Pandoraea genus arises from a re-examination of the species contained in the Burkholderia cepacia complex; it contains 9 species, of which only 5 are named: Pandoraea apista, Pandoraea pulmonicola, Pandoraea pnomenusa, P. sputorum and Pandoraea norimbergensis.2 The species-level identification of this new genus is complex, since they often present phenotypically similar patterns to other bacterial species. Pandoraea is a rare pathogen isolated in patients with septicaemia and chronic lung diseases, specifically cystic fibrosis.2–4

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.5 They have also been found in food, water, and mud.6

Antibiotic therapy for infections caused by species of the Pandoraea 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.2,4,7,8

P. sputorum 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.9

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 Pandoraea 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.

References
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Colonización por Pandoraea Sputorum en un paciente con fibrosis quística.
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Descripción de Pandoraea gen. nov. Con Pandoraea apista sp. Nov., Pandoraea pulmonicola sp. Nov., Pandoraea pnomenusa sp. Nov., Pandoraea sputorum sp. nov. Y el peine Pandoraea norimbergensis nov.
Int J Syst Evol Microbiol, 50 (2000), pp. 887-899

Please cite this article as: Monzón T, Valga F, Reichert J, López C, Colonización de catéter tunelizado para hemodiálisis por Pandoraea spotorum. Nefrologia. 2018;38:662–664.

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