{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,26]],"date-time":"2025-11-26T16:49:59Z","timestamp":1764175799398,"version":"3.41.2"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T00:00:00Z","timestamp":1750118400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Purpose<\/jats:title><jats:p><jats:italic>Burkholderia multivorans<\/jats:italic>, a Gram-negative bacterium, often infect patients with severe immunocompromised and cystic fibrosis. <jats:italic>B. multivorans<\/jats:italic> infection is challenging to treat due to its ability to disrupt the action of multiple antimicrobial agents through intrinsic and acquired resistance mechanisms. A better understanding of the pulmonary microbial spectrum of <jats:italic>B. multivorans<\/jats:italic> infection is crucial for the prevention and treatment of <jats:italic>B. multivorans<\/jats:italic>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>This case series reviewed the respiratory microbiome structure and alternations during the treatment of <jats:italic>B. multivorans<\/jats:italic> infection through metagenomic next-generation sequencing (mNGS). Analysis of mNGS data of 19 pharyngeal secretion samples collected from the 3 COVID-19 patients at different time points showed that the relative abundance of <jats:italic>B. multivorans<\/jats:italic> was fluctuated and eventually increased, indicating the possible development of drug resistance. A total of 40 antibiotic-resistant genes (ARGs) were detected. Significantly, the levels of CEOA, CEOB, and OPCM were consistent with the trends in the relative abundance of <jats:italic>B. multivorans<\/jats:italic>. Besides, we described nine previously uncharacterized non-synonymous mutations in <jats:italic>PenA<\/jats:italic> of <jats:italic>B. multivorans<\/jats:italic>. These mutations lead to amino acid changes Thr32Ala, Ala43Ser, Gln105Arg, Asn202Ser, Gln219Arg, Gly241Ala, Val259Ala, Thr279Ala, and Ser298Ile that may associate with resistance to \u03b2-lactam antibiotics.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This report shed light on the importance of rapidly diagnosis and treatment of <jats:italic>B. multivorans<\/jats:italic> infection. mNGS serve as a powerful microbial detection tool that provides a comprehensive, sensitive, and rapid method for pathogen detection and drug resistance analysis.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1577363","type":"journal-article","created":{"date-parts":[[2025,6,17]],"date-time":"2025-06-17T05:29:47Z","timestamp":1750138187000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Pulmonary microbial spectrum of Burkholderia multivorans infection identified by metagenomic 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