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Review
. 2022 Feb 17;19(4):2324.
doi: 10.3390/ijerph19042324.

The Gram-Negative Bacilli Isolated from Caves- Sphingomonas paucimobilis and Hafnia alvei and a Review of Their Involvement in Human Infections

Mihaela Ileana Ionescu  1   2 , Dan Ștefan Neagoe  2 , Alexandra Marioara Crăciun  1 , Oana Teodora Moldovan  3   4
Affiliations
Review

The Gram-Negative Bacilli Isolated from Caves- Sphingomonas paucimobilis and Hafnia alvei and a Review of Their Involvement in Human Infections

Mihaela Ileana Ionescu et al. Int J Environ Res Public Health. .

Abstract

The opportunistic infections with Gram-negative bacilli are frequently reported. The clinical studies are focused on the course of human infectious and very often the source of infection remain unclear. We aim to see if the Gram-negative bacilli isolated from a non-contaminated environment-the caves-are reported in human infections. Eleven samples were collected from six Romanian caves. We used the standard procedure used in our clinical laboratory for bacterial identification and for antibiotic susceptibility testing of the cave isolates. Out of the 14 bacterial strains, three isolates are Gram-negative bacilli-one isolate belong to Hafnia alvei and two strains belong to Sphingomonas paucimobilis. We screened for the published studies-full-text original articles or review articles-that reported human infections with S. paucimobilis and H. alvei. Data sources-PubMed and Cochrane library. We retrieved 447 cases from 49 references-262 cases (58.61%) are S. paucimobilis infections and 185 cases (41.39%) are H. alvei infections. The types of infections are diverse but there are some infections more frequent; there are 116 cases (44.27%) and many infections of the bloodstream with S. paucimobilius (116 cases) and 121 cases (65.41%) are urinary tract infections with H. alvei. The acquired source of the bloodstream infections is reported for 93 of S. paucimobilis bloodstream infections-50 cases (43%) are hospital-acquired, and 40 cases (37%) are community-acquired. Most of the infections are reported in patients with different underlying conditions. There are 80 cases (17.9%) are reported of previously healthy persons. Out of the 72 cases of pediatric infections, 62 cases (86.11%) are caused by S. paucimobilis. There are ten death casualties-three are H. alvei infections, and seven are S. paucimobilis infections.

Keywords: Hafnia alvei; Sphingomonas paucimobilis; bloodstream infections; cave environment; colistin resistance; identification methods; innate antibiotic resistance; opportunistic infections; pediatric infections; urinary tract infections.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flowchart of references selection.
Figure 2
Figure 2
The number of the references (study types) included in the present review.
Figure 3
Figure 3
The number of case reports/infections with S. paucimobilis and H. alvei retrieved from the 49 references included in the present review. The duplicated were excluded.
Figure 4
Figure 4
The number of cases with lethal outcomes of S. paucimobilis and H. alvei infections.
Figure 5
Figure 5
The source of infection is associated with bloodstream infections. Standard deviation s. S. paucimobilis s = 15.67; H. alvei s = 3.08.
Figure 6
Figure 6
The comparison of the pediatric S. paucimobilis and H. alvei infections according to age.
Figure 7
Figure 7
The comparison of health-control groups with the S. paucimobilis small airway disease (Eckrick et al.) and H. alvei diarrhea (Ridell et al.), respectively.
Figure 8
Figure 8
The bacteriological diagnostic was reported on the 49 references included in the study. (a) Identification methods; (b) antimicrobial susceptibility testing. NS—not specified, Phoenix BD-PAMS—BD Phoenix Automated Microbiology System and gas-liquid chromatography, GLC—gas-liquid chromatography; CBT- conventional biochemical tests.
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