MICs of antibiotics against Cupriavidus pauculus and metallidurans clinical strains, determined by the broth microdilution method

Amoxicillin/clavulanate

Note: bacterial strains were collected from French institutions, which may not reflect susceptibility patterns seen in the United States

Case reports demonstrating treatment of systemic infection due to Cupriavidus Pauculus

Citation

Miftode et al., 2022

Levofloxacin 750 mg/day and trimethoprim-sulfamethoxazole 4 tab/daily

A 41-year-old female patient presented with scleroderma after travel to Thailand. The patient was admitted for sepsis due to Streptococcus pneumonia, with a respiratory infection caused by multi-drug resistant Psuedomonas aeroginosa and Stenotrophomonas maltophilia. Sepsis was improved with empiric antibiotic treatment, initially cefotaxime and doxycycline, modifed to vancomycin and imipenem based on susceptibility tests. However, a sudden aggravation in respiratory status was observed, including high fever, severe productive cough, and vomica on the 6th day of hospitalization. The patient was continued on ampicillin 10 g/day and levofloxacin and trimethoprim-sulfamethoxazole x 14 days. Sputum samples eventually identified C. pauculus, and patient was continued on 7-day course of levofloxacin and trimethoprim-sulfamethoxazole, which was effective. Symptoms improved and biological markers and imaging tests demonstrated regression. 

Tian et al., 2022

A 38-year-old male patient presented with intermittent fever x 8 days. He was diagnosed with Graves hyperthyroidism 3 months earlier, and was treated with oral methimazole tablets, invoking suspicion of secondary infection caused by leucopenia induced by methimazole. Patient was empirically started on ceftazidime tazobactam sodium (2.4 g, twice a day) and levofloxacin lactate (0.6 g, once a day) for anti-infection therapy. Bone marrow culture identified C. pauculus and antibiotic treatment was upgraded to meropenem (1000 mg, 3 times daily). After 3 days of treatment anti-inflammatory index decreased but patient was still febrile, suggesting additional underlying cause. Pathological examination of swollen lymph node revealed histiocytic necrotizing lymphadenitis, successfully treated with steroids. 

Gomes et al., 2021

A 90-year-old male patient presented to the emergency room with septic shock and diagnosed with urinary tract infection. The patient was initially treated for multiresistant Kelbsiella pneumonia in the urine with amikacin and fosfomycin, however, his clinical status deteriorated during the hospital stay. When his condition got worse, flucloxacillin was added for suspected Staphylococcus aureus infection. Three days later, C. pauculus blood cultures were obtained with susceptibility only to minocycline, which was added to treatment. Unfortunately, the patient's status continued to deteriorate and he ended up dying.

Valdes-Corona et al., 2021

A preterm male neonate was admitted to the Neonatal Intensive Care Unit (NICU) due to hydrocephalus and hyaline membrane disease (HMD). The patient required invasive mechanical ventilation (IMV), surfactant administration, nasogastric tube placement, and both umbilical and percutaneous catheter insertion. Extubation was successfully achieved within the first 72 hours. Total parenteral nutrition (TPN) was initiated, and the neonate subsequently developed bacteremia, characterized by chills and fever. Blood cultures isolated C. pauculus as the causative agent. The patient was treated with a combination of piperacillin-tazobactam and amikacin, resulting in a favorable clinical outcome. The neonate was discharged from the NICU three weeks later.

A female preterm neonate was admitted to the NICU due to respiratory failure and patent ductus arteriosus (PDA). The patient required IMV, nasogastric tube placement, and umbilical catheter insertion. TPN was initiated, and the neonate developed fever and chills within the subsequent 24 hours. Blood cultures isolated C. pauculus as the causative agent. Despite treatment with piperacillin-tazobactam, the patient unfortunately succumbed to her condition 48 hours later.

A 2-year and 9-month-old male was admitted for empyema management. The patient underwent pleural decortication, with subsequent placement of a chest tube and central venous catheter (CVC). TPN was initiated, and within the first 24 hours, the patient developed a fever. Blood cultures identified C. pauculus as the causative agent. The patient was initially treated with piperacillin-tazobactam and vancomycin, resulting in a favorable clinical outcome. The patient was discharged on an oral treatment regimen of levofloxacin.

Shenai et al., 2019

A 64-year-old female with history of medically refractory Parkinson's disease underwent magnetic resonance imaging-guided bilateral subthalamic deep brain stimulation (DBS). While surgery was successful, the patient developed signs of generator pocket infection, revealing multispecies growth including C. pauculus. The growth, however, was deemed questionable due to low quantity but was later decided to be clinically significant. The patient was treated with a six-week course of intravenous ceftazidime. Two months later, the patient developed dehiscence and purulence due to non-compliant behavior. Wound cultures were negative and the patient was treated with cefepime for 2 weeks.

Bianco et al., 2018

A 48-year-old woman with obesity and hypertension was referred for diagnosis of myelomonocytic leukemia and chemotherapy was initiated. On day 9 of hospitalization, the patient became hypotensive, tachycardic, tachypnoeic, febrile and oligoanuric. Initial treatment consisted of meropenem, vancomycin, and caspofungin until gram-negative rods were identified in blood cultures, leading to discontinuation of vancomycin and caspofungin. Incubation of samples eventually revealed C. pauculus and in vitro antimicrobial susceptibility was performed on the isolate. Following the result, ciprofloxacin 400 mg Q12hours was added to meropenem and antimicrobial therapy continued for 10 days. The patient was successfully discharged on day 28.

Uzodi et al., 2014

A 15-month-old boy was transferred for a heart transplant. The patient's respiratory status deteriorated due to bacteremia and empiric treatment began with cefepime, vancomycin, and fluconazole. The source of infection was found to be caused by C. pauculus from the thermoregulator reservoir. The organism was identified to be susceptible to cefepime, ceftazidime, piperacillin/tazobactam, quinolones, and trimethoprim/sulfamethoxazole. Antibiotic treatment was complicated during the course of stay but mainly consisted of cefepime at 100 mg/kg/day divided Q12hours. Ciprofloxacin was added to ensure clearance on day 8 at 30 mg/kg/day, divided Q8hours while the cefepime dose was increased to 150 mg/kg/day divided Q8hours. Ciprofloxacin was discontinued 3 days after the oxygenator change out, and three consecutive negative cultures were documented. Cefepime dose was decreased back down to 100 mg/kg/day divided Q12hours and was eventually used to complete treatment.

Duggal et al., 2013

A 6-day old neonate presented with fever, poor feeding, lethargy, and abnormal cry. Examinations revealed motile bacilli which was initially identified as Pseudomonas but was later identified as C. pauculus. The isolate was susceptible to ceftazidime, levofloxacin, co-trimoxazole, amoxicillin/clavulanic acid, piperacillin/tazobactam, ticarcillin/clavulanic acid, imipenem, and meropenem; intermediate susceptibility to ciprofloxacin was reported and the isolate was resistant to amikacin, gentamicin, tobramycin, ceftriaxone, cefotaxime, aztreonam, and tetracycline. The antibiotics regimen was changed to ceftazidime 150 mg/kg/day in two divided doses without steroids and the patient was discharged on week 3 in stable condition.