What is the treatment for Sphingomonas paucimobilis infection, especially in the context of bromhidrosis?

Treatment of Sphingomonas paucimobilis Infection

Fluoroquinolones, particularly ciprofloxacin, are the first-line treatment for Sphingomonas paucimobilis infections, including those associated with bromhidrosis. 1, 2

Antimicrobial Therapy Options

First-line Treatment:

• Ciprofloxacin 500mg twice daily for 7-14 days depending on infection severity 3, 1
• This is particularly effective for:
  • Skin and soft tissue infections (including bromhidrosis)
  • Urinary tract infections
  • Respiratory infections

Alternative Options (based on susceptibility testing):

• Levofloxacin 750mg daily 3, 4
• Carbapenems (such as meropenem) for severe infections 4
• Beta-lactam/beta-lactamase inhibitor combinations (e.g., piperacillin-tazobactam) 2

Treatment Algorithm Based on Infection Site

For Bromhidrosis Associated with S. paucimobilis:

1. Oral ciprofloxacin 500mg twice daily for 7 days 1
2. Concurrent use of antibacterial soap and topical antibacterial agents
3. Follow-up after one week to confirm resolution

For Bloodstream Infections:

1. Obtain blood cultures before initiating therapy
2. Empiric therapy: Fluoroquinolone (ciprofloxacin or levofloxacin) 2
3. Adjust therapy based on susceptibility results
4. Treatment duration: 10-14 days 3
5. Remove any infected catheters if catheter-related bloodstream infection is suspected 5

For Peritoneal Dialysis-Associated Peritonitis:

1. Intraperitoneal plus intravenous antibiotics based on susceptibility 6
2. Consider catheter removal if no improvement after 72 hours of appropriate therapy 5, 6

Special Considerations

Immunocompromised Patients:

• Consider longer treatment duration (14+ days) 3
• More aggressive monitoring for treatment response
• Lower threshold for combination therapy in severe infections 3

Endocarditis:

• Extended therapy (4-6 weeks)
• Consider combination therapy with meropenem and levofloxacin for severe cases 4

Monitoring Response

• Clinical improvement should be evident within 72 hours 3
• If no improvement after 72 hours:
  • Repeat cultures
  • Consider alternative diagnoses
  • Evaluate for complications (abscess, endocarditis)
  • Consider changing antimicrobial therapy

Important Caveats

• Despite being considered a low-virulence organism, S. paucimobilis can cause serious infections including septic shock 2
• Resistance patterns vary, so antimicrobial susceptibility testing is crucial
• For bromhidrosis specifically, addressing the underlying bacterial cause rather than just symptomatic treatment leads to better outcomes 1, 7
• In cases of catheter-related infections, catheter removal may be necessary for complete resolution 5, 6

The case report of bromhidrosis caused by S. paucimobilis demonstrated complete resolution after one week of ciprofloxacin treatment 1, suggesting that targeted antimicrobial therapy addressing the specific pathogen is highly effective for this condition.