{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T21:54:37Z","timestamp":1790805277082,"version":"4.1.0"},"reference-count":51,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2024,11,16]],"date-time":"2024-11-16T00:00:00Z","timestamp":1731715200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives:\u00a0Pandoraea species are Gram-negative, aerobic, rod-shaped bacteria that belong to the Burkholderiaceae family and the Betaproteobacteria class. Despite their rare occurrence in the general population, they have been increasingly observed as the causes of infection in immunocompromised individuals or patients with severe comorbidities. The present review seeks to examine all documented cases of Pandoraea spp. infections in humans, focusing on data related to epidemiology, microbiology, antimicrobial susceptibility, treatment options, and mortality rates. Methods: A systematic review was conducted through a literature search of the PubMed\/MedLine and Scopus databases. This review is subjected to certain limitations regarding the data accuracy or pathogen identification molecular techniques applied in the studies. Results: In total, 29 studies provided information on 43 patients with Pandoraea spp. infections. The mean age of the patients was 42 years, and 58% were male. Cystic fibrosis was these patients\u2019 most prevalent risk factor (39.5%). The most frequently reported types of infection were lower respiratory tract infections (74.41%) and bacteremia (30.23%), followed by infective endocarditis, pancreatitis, upper respiratory tract infection, and osteomyelitis (4.65%). P. apista was the most regularly isolated species (37.2%), while antimicrobial resistance was lower for carbapenems, especially for imipenem (17.14%). The most commonly administered antibiotics included carbapenems (82%), cephalosporins, and trimethoprim\/sulfamethoxazole (35.89%). The infection outcome primarily depended on the type of infection; mortality rates were high (30.23%) and particularly elevated for bloodstream infections. The protocol for this review was registered in Prospero (ID: CRD42024579385). Conclusions: Due to Pandoraea\u2019s unique antimicrobial resistance pattern and capacity to induce severe infection, clinicians should include it when making a differential diagnosis, especially in patients with severe comorbidities and immunodeficiency.<\/jats:p>","DOI":"10.3390\/jcm13226905","type":"journal-article","created":{"date-parts":[[2024,11,19]],"date-time":"2024-11-19T09:30:25Z","timestamp":1732008625000},"page":"6905","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Pandoraea Infections in Humans\u2014A Systematic Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5853-5522","authenticated-orcid":false,"given":"Afroditi","family":"Ziogou","sequence":"first","affiliation":[{"name":"Department of Medical Oncology, Metaxa Cancer Hospital of Piraeus, 18537 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0570-8510","authenticated-orcid":false,"given":"Alexios","family":"Giannakodimos","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Metaxa Cancer Hospital of Piraeus, 18537 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2267-8464","authenticated-orcid":false,"given":"Ilias","family":"Giannakodimos","sequence":"additional","affiliation":[{"name":"Department of Urology, Attikon University General Hospital of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-0759","authenticated-orcid":false,"given":"Andreas G.","family":"Tsantes","sequence":"additional","affiliation":[{"name":"Laboratory of Hematology and Blood Bank Unit, School of Medicine, Attikon University General Hospital of Athens, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1082-5674","authenticated-orcid":false,"given":"Petros","family":"Ioannou","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Crete, 71003 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,11,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"908","DOI":"10.1111\/j.1469-0691.2008.02070.x","article-title":"Then and now: Use of 16S rDNA gene sequencing for bacterial identification and discovery of novel bacteria in clinical microbiology laboratories","volume":"14","author":"Woo","year":"2008","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e11699","DOI":"10.7717\/peerj.11699","article-title":"Identification of pathogen(s) in infectious diseases using shotgun metagenomic sequencing and conventional culture: A comparative study","volume":"9","author":"Chen","year":"2021","journal-title":"PeerJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1099\/00207713-50-2-887","article-title":"Description of Pandoraea gen. nov.with Pandoraea apista sp. nov., Pandoraea pulmonicola sp. nov., Pandoraea pnomenusa sp. nov., Pandoraea sputorum sp. nov. and Pandoraea norimbergensis comb. nov","volume":"50","author":"Coenye","year":"2000","journal-title":"Int. J. Syst. Evol. Microbiol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1097\/MCP.0000000000000517","article-title":"Emerging Gram-negative bacteria: Pathogenic or innocent bystanders","volume":"24","author":"Green","year":"2018","journal-title":"Curr. Opin. Pulm. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1099\/ijsem.0.003147","article-title":"Pandoraea fibrosis sp. nov., a novel Pandoraea species isolated from clinical respiratory samples","volume":"69","author":"Ambrose","year":"2019","journal-title":"Int. J. Syst. Evol. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3359","DOI":"10.2147\/IDR.S227643","article-title":"Pandoraea sputorum Bacteremia In A Patient Who Had Undergone Allogeneic Liver Transplantation Plus Immunosuppressive Therapy: A Case Report","volume":"12","author":"Xiao","year":"2019","journal-title":"Infect. Drug Resist."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Degand, N., Lotte, R., Decond\u00e9 Le Butor, C., Segonds, C., Thouverez, M., Ferroni, A., Vallier, C., M\u00e9ly, L., and Carr\u00e8re, J. (2015). Epidemic spread of Pandoraea pulmonicola in a cystic fibrosis center. BMC Infect. Dis., 15.","DOI":"10.1186\/s12879-015-1327-8"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1002\/2052-2975.16","article-title":"Pandoraea pulmonicola chronic colonization in a cystic fibrosis patient, France","volume":"1","author":"Kokcha","year":"2013","journal-title":"New Microbes New Infect."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1002\/ppul.10383","article-title":"Epidemic spread of Pandoraea apista, a new pathogen causing severe lung disease in cystic fibrosis patients","volume":"36","author":"Johansen","year":"2003","journal-title":"Pediatr. Pulmonol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2255","DOI":"10.1128\/JCM.41.5.2255-2257.2003","article-title":"Sepsis, multiple organ failure, and death due to Pandoraea pnomenusa infection after lung transplantation","volume":"41","author":"Stryjewski","year":"2003","journal-title":"J. Clin. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"447","DOI":"10.25259\/SNI_472_2021","article-title":"Skull base osteomyelitis by Pandoraea apista: An unusual pathogen at unusual location\u2014A case report","volume":"12","author":"Patil","year":"2021","journal-title":"Surg. Neurol. Int."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Martina, P.F., Mart\u00ednez, M., Frada, G., Alvarez, F., Leguizam\u00f3n, L., Prieto, C., Barrias, C., Bettiol, M., Lagares, A., and Bosch, A. (2017). First time identification of Pandoraea sputorum from a patient with cystic fibrosis in Argentina: A case report. BMC Pulm. Med., 17.","DOI":"10.1186\/s12890-017-0373-y"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"n160","DOI":"10.1136\/bmj.n160","article-title":"PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1080\/09674845.2002.11978036","article-title":"Pandoraea apista isolated from a patient with cystic fibrosis: Problems associated with laboratory identification","volume":"59","author":"Moore","year":"2002","journal-title":"Br. J. Biomed. Sci."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1097\/01.inf.0000136857.74561.3c","article-title":"Pandoraea bacteremia in a cystic fibrosis patient with associated systemic illness","volume":"23","author":"Johnson","year":"2004","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1128\/JCM.44.3.833-836.2006","article-title":"Chronic colonization with Pandoraea apista in cystic fibrosis patients determined by repetitive-element-sequence, PCR","volume":"44","author":"Atkinson","year":"2006","journal-title":"J. Clin. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3165","DOI":"10.1128\/JCM.00855-08","article-title":"Misidentification of Pandoraea sputorum isolated from sputum of a patient with cystic fibrosis and review of Pandoraea species infections in transplant patients","volume":"46","author":"Pimentel","year":"2008","journal-title":"J. Clin. Microbiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1128\/JCM.05730-11","article-title":"Clinical and microbiological features of a cystic fibrosis patient chronically colonized with Pandoraea sputorum identified by combining 16S rRNA sequencing and matrix-assisted laser desorption ionization-time of flight mass spectrometry","volume":"50","author":"Morosini","year":"2012","journal-title":"J. Clin. Microbiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1135","DOI":"10.1097\/INF.0000000000000843","article-title":"Persistent Infection Because of Pandoraea sputorum in a Young Cystic Fibrosis Patient Resistant to Antimicrobial Treatment","volume":"34","author":"Debelleix","year":"2015","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Ambrose, M., Malley, R.C., Warren, S.J., Beggs, S.A., Swallow, O.F., McEwan, B., Stock, D., and Roddam, L.F. (2016). Pandoraea pnomenusa Isolated from an Australian Patient with Cystic Fibrosis. Front. Microbiol., 7.","DOI":"10.3389\/fmicb.2016.00692"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1016\/j.nefroe.2018.06.013","article-title":"Hemodialysis catheter colonized by Pandoraea spotorum","volume":"38","author":"Valga","year":"2018","journal-title":"Nefrologia (Engl. Ed)."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Lin, C., Luo, N., Xu, Q., Zhang, J., Cai, M., Zheng, G., and Yang, P. (2019). Pneumonia due to Pandoraea apista after evacuation of traumatic intracranial hematomas:a case report and literature review. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-4420-6"},{"key":"ref_23","first-page":"177","article-title":"Pandoraea sp. infection in a lung transplant patient and the critical role of MALDI-TOF in accurate bacterial identification","volume":"5","author":"Boutin","year":"2020","journal-title":"J. Assoc. Med. Microbiol. Infect. Dis. Can."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.jccase.2020.12.003","article-title":"Prosthetic aortic valve dehiscence following infective endocarditis by a rare bacterium\u2014Pandoraea pnomenusa","volume":"24","author":"Gawalkar","year":"2020","journal-title":"J. Cardiol. Cases"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1007\/s10096-021-04235-0","article-title":"Fatal Pandoraea nosoerga infection after combined liver-lung transplantation for cystic fibrosis: A recontamination by the pre-transplantation strain","volume":"40","author":"Peyclit","year":"2021","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_26","first-page":"e19498","article-title":"Meropenem-Resistant Pandoraea Pneumonia in a Critically Ill Patient With COVID-19","volume":"13","author":"Dlewati","year":"2021","journal-title":"Cureus"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1319","DOI":"10.2147\/IDR.S301138","article-title":"Possible Prosthetic Valve Endocarditis by Pandoraea pnomenusa and Specific Virulence Mechanisms","volume":"14","author":"Bodendoerfer","year":"2021","journal-title":"Infect. Drug Resist."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1055\/s-0041-1730847","article-title":"Pandoraea apista Bacteremia in a COVID-Positive Man: A Rare Coinfection Case Report from North India","volume":"13","author":"Singh","year":"2021","journal-title":"J. Lab. Physicians"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"7043","DOI":"10.2147\/IDR.S388520","article-title":"Sepsis Due to Pandoraea sputorum Infection After Multiple Trauma in a Non-Cystic Fibrosis Patient: A Case Report from Southeast China","volume":"15","author":"Ma","year":"2022","journal-title":"Infect. Drug Resist."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Itoh, N., Akazawa, N., Ishibana, Y., Masuishi, T., Nakata, A., and Murakami, H. (2022). Clinical and microbiological features of obstructive cholangitis with bloodstream infection caused by Pandoraea apista identified by MALDI-TOF mass spectrometry and ribosomal RNA sequencing in a cancer patient. BMC Infect. Dis., 22.","DOI":"10.1186\/s12879-022-07514-z"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3390\/idr14020025","article-title":"Pandoraea pnomenusa Superinfection in a Patient with SARS-CoV-2 Pneumonia: First Case in the Literature","volume":"14","year":"2022","journal-title":"Infect. Dis. Rep."},{"key":"ref_32","first-page":"127","article-title":"Fever in a Patient with a Central Venous Catheter Colonized by Pandoraea pnomenusa","volume":"36","author":"Rodrigues","year":"2023","journal-title":"Acta Medica Port."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1111\/bjh.18556","article-title":"Green inclusions in peripheral blood neutrophils of a patient with Pandoraea apista bacteraemia","volume":"200","author":"Zhang","year":"2023","journal-title":"Br. J. Haematol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2393","DOI":"10.1017\/S1047951123001221","article-title":"Recombinant angiotensin II therapy in a child with cardiac dysfunction and Pandoraea and Candida sepsis","volume":"33","author":"Kim","year":"2023","journal-title":"Cardiol. Young"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.3201\/eid2911.230493","article-title":"Outbreak of Pandoraea commovens Infections among Non-Cystic Fibrosis Intensive Care Patients, Germany, 2019\u20132021","volume":"29","author":"Kruis","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1186\/s13052-019-0687-x","article-title":"Isolation and identification of Pandoraea spp. From bronchoalveolar lavage of cystic fibrosis patients in Iran","volume":"45","author":"Tabatabaei","year":"2019","journal-title":"Ital. J. Pediatr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5607","DOI":"10.1099\/ijsem.0.004332","article-title":"List of Prokaryotic names with Standing in Nomenclature (LPSN) moves to the DSMZ","volume":"70","author":"Parte","year":"2020","journal-title":"Int. J. Syst. Evol. Microbiol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Kostygov, A.Y., Butenko, A., Nenarokova, A., Tashyreva, D., Flegontov, P., Luke\u0161, J., and Yurchenko, V. (2017). Genome of Ca. Pandoraea novymonadis, an Endosymbiotic Bacterium of the TrypanosomatidNovymonasesmeraldas. Front. Microbiol., 8.","DOI":"10.3389\/fmicb.2017.01940"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1128\/JCM.39.5.1819-1826.2001","article-title":"Assignment of CDC weak oxidizer group 2 (WO-2) to the genus Pandoraea and characterization of three new Pandoraea genomospecies","volume":"39","author":"Daneshvar","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1099\/jmm.0.022657-0","article-title":"Virulence of an emerging respiratory pathogen, genus Pandoraea, in vivo and its interactions with lung epithelial cells","volume":"60","author":"Costello","year":"2011","journal-title":"J. Med. Microbiol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1097\/01.JAA.0000515540.36581.92","article-title":"Keep them breathing: Cystic fibrosis pathophysiology, diagnosis, and treatment","volume":"30","author":"Brown","year":"2017","journal-title":"JAAPA"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1128\/CMR.00036-10","article-title":"Clinical significance of microbial infection and adaptation in cystic fibrosis","volume":"24","author":"Hauser","year":"2011","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1164\/rccm.200304-505SO","article-title":"Pathophysiology and management of pulmonary infections in cystic fibrosis","volume":"168","author":"Gibson","year":"2003","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"4452","DOI":"10.1128\/JCM.39.12.4452-4455.2001","article-title":"Identification of Pandoraea species by 16S ribosomal DNA-based PCR assays","volume":"39","author":"Coenye","year":"2001","journal-title":"J. Clin. Microbiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1099\/jmm.0.47544-0","article-title":"Evaluation of in vitro virulence characteristics of the genus Pandoraea in lung epithelial cells","volume":"57","author":"Caraher","year":"2008","journal-title":"J. Med. Microbiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00203-015-1148-6","article-title":"Biofilm, pathogenesis and prevention--a journey to break the wall: A review","volume":"198","author":"Gupta","year":"2016","journal-title":"Arch. Microbiol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1097\/01.sla.0000103062.21049.82","article-title":"Perioperative recombinant human granulocyte colony-stimulating factor (Filgrastim) treatment prevents immunoinflammatory dysfunction associated with major surgery","volume":"239","author":"Schneider","year":"2004","journal-title":"Ann. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"3871","DOI":"10.3748\/wjg.v24.i34.3871","article-title":"Optimal immunosuppressor induces stable gut microbiota after liver transplantation","volume":"24","author":"Jiang","year":"2018","journal-title":"World J. Gastroenterol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"157","DOI":"10.1007\/978-3-319-11038-7_10","article-title":"Biofilm-based central line-associated bloodstream infections","volume":"830","author":"Yousif","year":"2015","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1111\/j.1462-2920.2007.01505.x","article-title":"Temporal and spatial archaeal colonization of hydrothermal vent deposits","volume":"10","author":"Tivey","year":"2008","journal-title":"Environ. Microbiol."},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"Slatko, B.E., Gardner, A.F., and Ausubel, F.M. (2018). Overview of Next-Generation Sequencing Technologies. Curr. Protoc. Mol. Biol., 122.","DOI":"10.1002\/cpmb.59"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6905\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:33:35Z","timestamp":1760114015000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/22\/6905"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11,16]]},"references-count":51,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["jcm13226905"],"URL":"https:\/\/doi.org\/10.3390\/jcm13226905","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,16]]}}}