# A Case of Pandoraea apista Bacteremia in an Immunosuppressed Ventriculoperitoneal (VP) Shunt Patient in Dubai Hospital, UAE

## TL;DR

A rare case of Pandoraea apista infection is reported in a non-CF immunosuppressed patient in the UAE, highlighting the need for accurate diagnosis and targeted treatment.

## Contribution

First documented case of P. apista bacteremia in the Middle East in a non-CF patient with indwelling devices.

## Key findings

- P. apista was identified in blood and urine cultures using MALDI-TOF MS.
- The bacteria showed resistance to ceftazidime and meropenem but responded to ciprofloxacin.
- The case underscores the importance of precise identification and susceptibility testing for effective treatment.

## Abstract

Pandoraea species are multidrug-resistant (MDR) Gram-negative bacteria increasingly recognized as opportunistic pathogens beyond cystic fibrosis (CF). To our knowledge, we report the first documented case of Pandoraea apista bacteremia in the Middle East, occurring in a 41-year-old non-CF woman with post-revision ventriculoperitoneal (VP) shunt hydrocephalus, metastatic cervical carcinoma, and renal failure. Presenting with fever, hematuria, and obstructive uropathy, the patient developed catheter-related bloodstream infection (CRBSI) and urinary tract infection. P. apista was identified via MALDI-TOF MS (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry) from blood and urine cultures, displaying resistance to ceftazidime and meropenem but susceptibility to ciprofloxacin, which led to clinical improvement.

This case highlights the emerging threat of P. apista in immunocompromised, non-CF patients with indwelling devices, emphasizing the critical role of precise microbiological identification and susceptibility-guided therapy in managing such infections.