The emerging clinical relevance and antimicrobial resistance of Pluralibacter gergoviae: a systematic review

Abstract

Background: Pluralibacter gergoviae is a gram-negative bacillus in the Enterobacteriaceae family. Although rarely associated with human infections, its resistance to preservatives and presence in hospital-use products raise concerns about nosocomial transmission.

Objectives: To describe the clinical and microbiological profiles of P. gergoviae infections.

Methods: A comprehensive search was conducted in multiple databases and grey literature without time restrictions. Eligibility criteria included: (1) studies reporting human infections by P. gergoviae and (2) patients with confirmed infections. Data were synthesized narratively and summarized as frequencies and proportions. Univariate and multivariate analyses assessed risk factors for multidrug resistance (MDR) and mortality.

Results: Of 371 articles retrieved, 16 met the inclusion criteria, and 18 additional studies were identified through grey literature and manual search, totalling 34 studies. Three described outbreaks, two in neonatal intensive care units (NICUs). Overall, 196 patients were identified, predominantly male (59%), with 66% of infections being healthcare-associated. Most were admitted to ICUs (74%), especially NICUs (70%). Bloodstream infections were most common, followed by periodontitis and urinary tract infections. Phenotypic methods were primarily used for identification. MDR was reported in 33% of strains; ESBL and carbapenemase production in 35% and 23% of cases, respectively. The most frequent carbapenemase genes were blaKPC, blaNDM, and blaIMP. Mortality occurred in 11% of cases, and all MDR-related deaths were associated with blaKPC. Prior antibiotic use was significantly associated with mortality (P = 0.039; OR: 13).

Conclusions: Pluralibacter gergoviae is rare but clinically relevant, with MDR potential and impact on vulnerable populations, particularly in NICU settings.