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Opportunistic infections by Brucella anthropi and Brucella intermedia: a case series of rare non-brucellosis diseases in Saudi Arabia

Amjad Bin Manea,Faisal Alnemer,Hoda Abanamy,B. Alalwan,Abdulellah Almohaya

Published 2025 in BMC Infectious Diseases

ABSTRACT

Recently reclassified under the Brucella genus, Ochrobactrum species are rare opportunistic pathogens in immunocompromised hosts, causing non-brucellosis diseases. They exhibit multi-drug resistance (including AmpC) and often require combination therapy. This is the first study from Saudi Arabia to review infections by Brucella anthropi and Brucella intermedia, focusing on clinical significance, resistance, and outcomes. A retrospective review was conducted on infections caused by B. anthropi and B. intermedia between January 2016 to December 2024. Data on patient demographics, infection type and location, microbial identification, and resistance patterns were collected. Treatment and therapy duration were reviewed, along with outcome assessment. Analysis of the rate of recovery and in-hospital mortality was performed. Over 8 years, a total of 18 unique cases were identified, after excluding 2 of which were deemed contaminated, totaling 16 cases included, 14 adult and 2 pediatric patients were identified as true infections. Presentations varied between septic shock, respiratory distress, and/or altered mental status. Diagnoses included catheter-related bloodstream infections (n = 9), intra-abdominal infection with or without bacteremia (n = 4), and VAP in the neonate (n = 2), catheter-associated urinary tract infection (CAUTI) (n = 1). B. anthropi was found in eleven (11/16) cases, and B. intermedia in four cases, in addition to one that was not identified to species level. Twelve were monomicrobial (12/16, 75%) and six had polymicrobial growth. Resistance to cephalosporins and piperacillin/tazobactam was observed, but all isolates were susceptible to carbapenems, TMP/SMX, and ciprofloxacin. Three deaths (3/16) were documented, and the remaining thirteen patients survived, and the overall survival rate was 81%. B. anthropi and B. intermedia infections are rare overall, mostly identified in blood cultures with variable clinical presentation. Although it can cause severe sepsis and has beta-lactam resistance, the overall outcome if promptly treated is favorable. The distinction from other brucellosis-causing species (B. melitensis and B. Abortus) is essential. Not applicable.

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