Nosocomial infection of extensively drug-resistant Myroides odoratimimus in a Turkish hospital

Objectives: Myroides spp. is an environmental pathogen and causes disease in immunocompromised patients. In this study, we report an outbreak of urinary tract infections caused by M. odoratimimus in a university hospital in Turkey. Methods: A total of 25 M. odoratimimus strains isolated from the clinical samples of 20 patients in our intensive care units and clinics were included in the study. Phenotypic and genotypic identification of isolates was performed using conventional methods, VITEK®-2 automated identification system, Matrix Assisted Laser Desorption/Ionisation-Time of Flight Mass Spectrometry and 16S-RNA Microbial Diagnosis methods. In addition, Repetitive Extragenic Palindromic Elements (REP) PCR Assay method was applied for molecular epidemiological analysis. Results: All cases were diagnosed with nosocomial urinary tract infection, except for one case diagnosed with nosocomial bacteraemia. One of the M. odoratimimus isolates was sensitive to piperacillin/tazobactam (MIC: ≤4 µg/ml) and one isolate was moderately sensitive to cefepime (MIC: 16 µg/ml). Other M. odoratimimus isolates were resistant to the tested antibiotics of beta lactams, monobactams, carbapenems, aminoglycosides, fluoroquinolones and sulphonamides. When 10 isolates were evaluated with the REP PCR method, DNA finger print similarities were visually determined and there was a similar DNA pattern among them. Myroides source was not detected in environmental samples. Conclusion: Clinicians should consider that Myroides spp. isolates with multiple and broad-spectrum drug resistance may be a serious nosocomial pathogen like Pseudomonas aeruginosa or Acinetobacter baumannii. In order to choose the best treatment regimen, this atypical pathogen needs to be quickly identified and antibiotic susceptibility tests performed.