Case report of multidrug resistant Myroides odoratimimus infection in a gastric cancer patient
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Key Takeaway
Note that urinary alkalinization may enhance minocycline efficacy against Myroides odoratimimus.
This case report details the clinical and laboratory findings regarding a Myroides odoratimimus infection in a patient with gastric cancer. The authors focused on the antimicrobial susceptibility of a urinary M. odoratimimus isolate and investigated the influence of environmental pH on antibiotic activity, alongside an in vivo evaluation using a murine urinary tract infection model.
Laboratory analysis revealed that the isolate exhibited multidrug resistance, remaining susceptible to only 1 of 24 antibiotics tested. Molecular analysis confirmed the presence of the beta-lactamase gene (blaMUS-1) as a mediator of this resistance. Regarding antibiotic activity under varying pH, tigecycline and minocycline demonstrated optimal activity under neutral conditions (pH 7.3), while piperacillin-tazobactam showed relatively improved activity at alkaline pH.
In the murine model, urinary alkalization to pH 8.5 significantly enhanced the antibacterial efficacy of minocycline. However, the certainty of these findings is limited because the primary results are based on a single clinical isolate and a murine model. Clinicians should note that urinary alkalinization may improve minocycline efficacy in Myroides infections, but further research is required to validate these observations in human populations.
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View Original Abstract ↓
IntroductionMyroides odoratimimus is a Gram-negative opportunistic pathogen primarily affecting immunocompromised individuals. However, its resistance characteristics and therapeutic response in cancer patients remain poorly defined. This study investigated the antimicrobial resistance profile of a urinary M. odoratimimus isolate from a gastric cancer patient and evaluated the influence of environmental pH on antibiotic efficacy.MethodsThe isolate was identified using the VITEK 2-Compact system, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS), and 16S ribosomal ribonucleic acid (16S rRNA) sequencing. Antimicrobial susceptibility testing against 24 antibiotics was performed using the VITEK 2 system according to Clinical and Laboratory Standards Institute (CLSI) M100 (Ed33) guidelines. Resistance genes were detected by polymerase chain reaction (PCR) and sequencing. The impact of pH (5.5–8.5) on antibiotic activity was assessed using disk diffusion. In vivo efficacy of minocycline was evaluated in a murine urinary tract infection model with controlled urine pH modulation.ResultsThe isolate showed 100% sequence identity with M. odoratimimus PR63069 and exhibited multidrug resistance, remaining susceptible only to minocycline. Molecular analysis confirmed the presence of the β-lactamase gene (blaMUS-1). Tigecycline and minocycline demonstrated optimal activity under neutral conditions (pH 7.3), whereas piperacillin–tazobactam showed relatively improved activity at alkaline pH. In vivo, urinary alkalization (pH 8.5) significantly enhanced the antibacterial efficacy of minocycline.ConclusionM. odoratimimus isolated from a gastric cancer patient demonstrated multidrug resistance mediated by blaMUS-1. Antibiotic activity varied with pH, and urine alkalinization improved minocycline efficacy, suggesting potential strategies for clinical management of Myroides infections.
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