Bordetella trematum bacteraemia secondary to an empyema in an immunocompromised host: A case report and review of the literature
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Introduction. Bordetella trematum infection remains uncommon. More cases of bacteraemia are reported in recent years with the primary infection largely originating from skin and soft tissue sites. Yet, our understanding of its virulence, antibiotic susceptibility profile and treatment is still limited.
Case presentation. We report the first case of B. trematum bacteraemia from a left-sided empyema. An 87-year-old female patient with a past medical history of ischaemic heart disease, diabetes mellitus complicated by nephropathy and locally advanced left breast adenocarcinoma presented with fever, productive cough and shortness of breath. The B. trematum isolates from blood and pleural fluid were identified by MALDI-TOF and 16S rRNA sequencing. Ceftriaxone and azithromycin commenced empirically on admission were switched to piperacillin-tazobactam after 2 days due to lack of clinical improvement. Despite a pleurocentesis and 1 week of piperacillin-tazobactam with microbiological clearance in blood, the patient continued to deteriorate. Decision to withdraw treatment was made in view of the patient’s prognosis, and the patient succumbed on the fourteenth day of admission. The isolate was susceptible to piperacillin-tazobactam, imipenem and meropenem but had reduced susceptibility or was non-susceptible to cefuroxime, cefotaxime, ceftazidime, cefepime, the aminoglycosides and fluoroquinolones.
Conclusion. Invasive B. trematum infection is associated with significant mortality. Consensus for antibiotic treatment remains unclear, with limited susceptibility data to support specific antibiotic use. We expect more clinical cases will surface with improved microbial identification systems, as well as enhanced clinical awareness. Standardized and more robust susceptibility work are needed to provide clear recommendations and establish consensus in treating invasive infections.
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The work presented is clear and the arguments well formed. Thank you for your resubmission, addressing reviewer concerns and elaborating on comments. I'm now happy to confirm the manuscript has now been accepted. Thank you for again and please do consider Access Microbiology again for future manuscripts. Best wishes, John.
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The work presented is clear and the arguments well formed. This study would be a valuable contribution to the existing literature. This is a study that would be of interest to the field and community.
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Comments to Author
"Title: B. trematum Bacteraemia Secondary to an Empyema in an Immunocompromised Host: A Case Report and Review of the Literature." The authors report a case of an 87 year old female patient with a Bordetella trematum infection. The patient succumbed 14 days after admission and antibiotic sensitivity screening was carried out on the isolate and the author raise concerns about limited literature knowledge on standard treatment approaches. The manuscript is generally well written, some minor comments below and the literature review and summary tables specifically will be of use to the community. Minor comments Line 1: Use full bacterial name in title. This will make accessing the paper easier and is good practice. Line 17: replace "lady" with "female patient" Line 57: remove "o" in tachypnoeic Line …
Comments to Author
"Title: B. trematum Bacteraemia Secondary to an Empyema in an Immunocompromised Host: A Case Report and Review of the Literature." The authors report a case of an 87 year old female patient with a Bordetella trematum infection. The patient succumbed 14 days after admission and antibiotic sensitivity screening was carried out on the isolate and the author raise concerns about limited literature knowledge on standard treatment approaches. The manuscript is generally well written, some minor comments below and the literature review and summary tables specifically will be of use to the community. Minor comments Line 1: Use full bacterial name in title. This will make accessing the paper easier and is good practice. Line 17: replace "lady" with "female patient" Line 57: remove "o" in tachypnoeic Line 62: please the Greek "μ" for micro litre. Here and throughout. Line 64: please confirm the units are correct and consistant Line 78-80: consistency in Gram negative/Gram-negative Line 91 and entire paragraph: spaces between numbers and units. Line 120: provide a reference to sceptics or I would suggest removal of the comment unless you are directly suggesting it. Line 204: I suggest removing the idiom (rearing its head)
Please rate the quality of the presentation and structure of the manuscript
Good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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Comments to Author
B. trematum Bacteraemia Secondary to an Empyema in an Immunocompromised Host: A Case Report and Review of the Literature. In this manuscript, the authors presented a case report of an 87-year-old female patient with bacteremia from a left-sided empyema. Bordetella trematum was isolated from blood and pleural fluid and despite the antibiotic treatment, the patient died 14 days after admission. 1. Description of the case(s) Line 1: as this is the first time the name of the bacterium appears, I suggest not abbreviating the genus. Line 7: to designate the biological sex, it is better to use the term "female patient" instead of "lady". Line 34: as the term "Bordetella trematum" appears in the title, a different keyword could be used instead. 2. Presentation of results Line 57: there is a typo in …
Comments to Author
B. trematum Bacteraemia Secondary to an Empyema in an Immunocompromised Host: A Case Report and Review of the Literature. In this manuscript, the authors presented a case report of an 87-year-old female patient with bacteremia from a left-sided empyema. Bordetella trematum was isolated from blood and pleural fluid and despite the antibiotic treatment, the patient died 14 days after admission. 1. Description of the case(s) Line 1: as this is the first time the name of the bacterium appears, I suggest not abbreviating the genus. Line 7: to designate the biological sex, it is better to use the term "female patient" instead of "lady". Line 34: as the term "Bordetella trematum" appears in the title, a different keyword could be used instead. 2. Presentation of results Line 57: there is a typo in "tachypnoeic". Lines 62-66 and 84-87: what are the reference values in the authors' laboratory? Lines 73-75: what is the posology of the medications? Lines 37, 79, 80 an 87: standardizes the writing of "Gram negative/Gram-negative". Line 91: as the first sentence of this paragraph still refers to the bacterial identification test, it can be added to the previous paragraph. Lines 107-108: what was the cause of death? 3. How the style and organization of the paper communicates and represents key findings A timeline of key case events can help visualize the course of the infection. 4. Literature analysis or discussion Line 91: as the first sentence of this paragraph still refers to the bacterial identification test, it can be added to the previous paragraph. Lines 107-108: what was the cause of death? Lines 120-121: I suggest removing the phrase "it is therefore not unexpected for sceptics to question the role of B. trematum as a pathogen in its own right". Lines 123-127: could the different clinical conditions of the patients have led to different outcomes? What are the similarities and differences with this case report? 5. Any other relevant comments Line 241: Is there any ethical approval? In several parts of the text terms such as "she/her" are used referring to the patient. I suggest replacing to "the patient". Table 2: in items 7 and 8, age/sex column is missing the letter y after age.
Please rate the quality of the presentation and structure of the manuscript
Very good
To what extent are the conclusions supported by the data?
Strongly support
Do you have any concerns of possible image manipulation, plagiarism or any other unethical practices?
No
Is there a potential financial or other conflict of interest between yourself and the author(s)?
No
If this manuscript involves human and/or animal work, have the subjects been treated in an ethical manner and the authors complied with the appropriate guidelines?
Yes
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