Research Article| Volume 137, P8-16, July 2023

An increasing threat in intensive care units: evaluation of multi-drug-resistant Myroides spp. infections and risk factors

  • A. Gülmez
    Corresponding author. Address: Istanbul Başakşehir Çam and Sakura City Hospital, Medical Microbiology Laboratory, Olympiyat Boulevard Road, 34480, Istanbul, Turkey. Tel.: +90 2129096000
    Istanbul Başakşehir Çam and Sakura City Hospital, Medical Microbiology Laboratory, Istanbul, Turkey
    Search for articles by this author
  • A.N. Ceylan
    Istanbul Başakşehir Çam and Sakura City Hospital, Medical Microbiology Laboratory, Istanbul, Turkey
    Search for articles by this author
  • O. Özalp
    Istanbul Başakşehir Çam and Sakura City Hospital, Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
    Search for articles by this author
Published:April 22, 2023DOI:



      Myroides spp. are Gram-negative bacilli that are commonly found in soil and water, acting as low-level opportunistic pathogens and causing a variety of infections.


      To assess the risk factors for multi-drug-resistant myroides infections, association with comorbid illnesses, patient care and susceptibility to antibiotics.


      This retrospective analytical study was conducted in Istanbul Başakşehir Çam and Sakura City Hospital, and included patients with Myroides spp. isolated in their culture samples. Total hospitalization days, first isolation day and 30-day mortality values of the patients were analysed statistically, and P<0.05 was considered to indicate significance.


      Myroides spp. were isolated from 437 culture samples from 228 patients. Of these cases, 210 (92.1%) were classified as having asymptomatic bacteriuria, and 18 (7.9%) as having an infection caused by Myroides spp. One hundred and seventy-four (76.3%) patients were followed up in the intensive care unit, and total hospitalization days (median 24.5 days) and first isolation day (median 9.5 days) of infected patients were shorter than those for colonized patients (P=0.023 and 0.030, respectively). No difference was found in 30-day mortality between infected and colonized patients (P=0.312).


      Myroides infections were seen more frequently in patients who were hospitalized for a long time, used broad-spectrum antimicrobials, underwent invasive procedures, and had co-factors such as diabetes and cerebrovascular disease. In addition, the resistance rates of Myroides odoratus were higher than those of Myroides odoratimimus, and the use of quinolones for the treatment of patients with M. odoratimimus infection led to a higher cure rate.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Stutzer M.
        • Kwaschnina A.
        Aussaaten aus den Fäzes des Menschen gelbe Kolonien bildende Bakterien (Gattung Flavobacterium ua).
        Zentralbl Bakteriol Parasitenkd Infektionskr Hyg Abt. 1929; 1: 219-225
        • Vancanneyt M.
        • Segers P.
        • Torck U.
        • Hoste B.
        • Bernardet J.-F.
        • Vandamme P.
        • et al.
        Reclassification of Flavobacterium odoratum (Stutzer 1929) strains to a new genus, Myroides, as Myroides odoratus comb. nov. and Myroides odoratimimus sp. nov.
        Int J System Evolut Microbiol. 1996; 46: 926-932
        • Holmes B.
        • Snell J.J.
        • Lapage S.P.
        Flavobacterium odoratum: a species resistant to a wide range of antimicrobial agents.
        J Clin Pathol. 1979; 32: 73-77
        • Endicott-Yazdani T.R.
        • Dhiman N.
        • Benavides R.
        • Spak C.W.
        Myroides odoratimimus bacteremia in a diabetic patient.
        Proc (Bayl Univ Med Cent). 2015; 28: 342-343
        • Elantamilan D.
        • Lyngdoh V.W.
        • Choudhury B.
        • Khyriem A.B.
        • Rajbongshi J.
        Septicaemia caused by Myroides spp.: a case report.
        JMM Case Rep. 2015; 2e000097
        • Willems P.
        • Muller J.
        • Verhaegen J.
        • Saegeman V.
        • Desmet S.
        How to treat a fulminant erysipelas and sepsis caused by Myroides odoratimimus: case report and literature review.
        Acta Clin Belg. 2017; 72: 331-335
        • Beharrysingh R.
        Myroides bacteremia: a case report and concise review.
        IDCases. 2017; 8: 34-36
        • Benedetti P.
        • Rassu M.
        • Pavan G.
        • Sefton A.
        • Pellizzer G.
        Septic shock, pneumonia, and soft tissue infection due to Myroides odoratimimus: report of a case and review of myroides infections.
        Infection. 2011; 39: 161-165
        • Maraki S.
        • Sarchianaki E.
        • Barbagadakis S.
        Myroides odoratimimus soft tissue infection in an immunocompetent child following a pig bite: case report and literature review.
        Braz J Infect Dis. 2012; 16: 390-392
        • Yağci A.
        • Cerikçioğlu N.
        • Kaufmann M.E.
        • Malnick H.
        • Söyletir G.
        • Babacan F.
        • et al.
        Molecular typing of Myroides odoratimimus (Flavobacterium odoratum) urinary tract infections in a Turkish hospital.
        Eur J Clin Microbiol Infect Dis. 2000; 19: 731-732
        • Ktari S.
        • Mnif B.
        • Koubaa M.
        • Mahjoubi F.
        • Ben Jemaa M.
        • Mhiri M.N.
        • et al.
        Nosocomial outbreak of Myroides odoratimimus urinary tract infection in a Tunisian hospital.
        J Hosp Infect. 2012; 80: 77-81
        • Licker M.
        • Sorescu T.
        • Rus M.
        • Cirlea N.
        • Horhat F.
        • Jurescu C.
        • et al.
        Extensively drug-resistant Myroides odoratimimus – a case series of urinary tract infections in immunocompromised patients.
        Infect Drug Resist. 2018; 11: 743-749
        • Sharma S.
        • Gupta A.
        • Rao D.
        Myroides species: a rare cause of endocarditis.
        IJSS Case Rep Rev. 2016; 2: 15-16
        • Harris C.
        • Musty S.
        • Kundal S.
        • Sharma K.
        • Seneviratne C.
        Myroides bacteremia and ventriculitis.
        Ann Clin Case Rep. 2020; 5: 1867
        • Crum-Cianflone N.F.
        • Matson R.W.
        • Ballon-Landa G.
        Fatal case of necrotizing fasciitis due to Myroides odoratus.
        Infection. 2014; 42: 931-935
        • Ainarozidou A.
        • Evans A.
        Myroides odoratimimus necrotising fasciitis and recurrent bacteraemia in an immunosuppressed patient with chronic leg ulcers: an emerging pattern?.
        Access Microbiol. 2020; 2: 106
        • Schröttner P.
        • Rudolph W.W.
        • Eing B.R.
        • Bertram S.
        • Gunzer F.
        Comparison of VITEK2, MALDI-TOF MS, and 16S rDNA sequencing for identification of Myroides odoratus and Myroides odoratimimus.
        Diagn Microbiol Infect Dis. 2014; 79: 155-159
        • Yang S.
        • Liu Q.
        • Shen Z.
        • Wang H.
        • He L.
        Molecular epidemiology of Myroides odoratimimus in nosocomial catheter-related infection at a general hospital in China.
        Infect Drug Resist. 2020; 13: 1981-1993
        • McGeer A.
        • Campbell B.
        • Emori T.G.
        • Hierholzer W.J.
        • Jackson M.M.
        • Nicolle L.E.
        • et al.
        Definitions of infection for surveillance in long-term care facilities.
        Am J Infect Control. 1991; 19: 1-7
        • Stone N.D.
        • Ashraf M.S.
        • Calder J.
        • Crnich C.J.
        • Crossley K.
        • Drinka P.J.
        • et al.
        Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria.
        Infect Control Hosp Epidemiol. 2012; 33: 965-977
        • European Committee on Antimicrobial Susceptibility Testing
        Breakpoint tables for interpretation of MICs and zone diameters.
        2020 (Available at:)
        • Bektas S.
        • Tümtürk A.
        • Akdağ A.
        • Izdes S.
        An outbreak of urinary tract infections due to Myroides spp in adult intensive care unit: risk factors and control procedures.
        J Cardio Vasc Thorac Anaesthes Intensive Care Soc. 2021; 27: 210-215
        • Pompilio A.
        • Galardi G.
        • Gherardi G.
        • Verginelli F.
        • Geminiani C.
        • Pilloni A.P.
        • et al.
        Infection of recurrent calcaneal ulcer caused by a biofilm-producer Myroides odoratimimus strain.
        Folia Microbiol (Praha). 2018; 63: 203-207
        • James G.A.
        • Swogger E.
        • Wolcott R.
        • Pulcini Ed
        • Secor P.
        • Sestrich J.
        • et al.
        Biofilms in chronic wounds.
        Wound Repair Regenerat. 2008; 16: 37-44
        • Macfarlane D.E.
        • Baum-Thureen P.
        • Crandon I.
        Flavobacterium odoratum ventriculitis treated with intraventricular cefotaxime.
        J Infect. 1985; 11: 233-238
        • Gonzales Zamora J.A.
        • Baez Presser J.
        Bacterial meningitis caused by myroides in a patient with cerebrospinal fluid leakage.
        Infect Dis Clin Pract. 2018; 26: e11
        • Bhat V.
        • Vira H.
        • Shetty P.
        • Gupta S.
        Myroides odoratus central nervous infection in a postneurosurgery patient.
        Ind J Med Paediatr Oncol. 2019; 40: 291
        • Weiner L.M.
        • Webb A.K.
        • Limbago B.
        • Dudeck M.A.
        • Patel J.
        • Kallen A.J.
        • et al.
        Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014.
        Infect Control Hosp Epidemiol. 2016; 37: 1288-1301
        • Bonten M.J.
        • Mascini E.M.
        The hidden faces of the epidemiology of antibiotic resistance.
        Intensive Care Med. 2003; 29: 1-2
        • Mammeri H.
        • Bellais S.
        • Nordmann P.
        Chromosome-encoded beta-lactamases TUS-1 and MUS-1 from Myroides odoratus and Myroides odoratimimus (formerly Flavobacterium odoratum), new members of the lineage of molecular subclass B1 metalloenzymes.
        Antimicrob Agents Chemother. 2002; 46: 3561-3567
        • Ming D.S.
        • Chen Q.Q.
        • Chen X.T.
        Analysis of resistance genes in pan-resistant Myroides odoratimimus clinical strain PR63039 using whole genome sequencing.
        Microb Pathog. 2017; 112: 164-170
        • Burghartz M.
        • Bunk B.
        • Spröer C.
        • Voget S.
        • Daniel R.
        • Overmann J.
        • et al.
        Complete genome sequence of the urethral catheter isolate Myroides sp. A21.
        Genome Announc. 2015; 3
        • Gunzer F.
        • Rudolph W.W.
        • Bunk B.
        • Schober I.
        • Peters S.
        • Müller T.
        • et al.
        Whole-genome sequencing of a large collection of Myroides odoratimimus and Myroides odoratus isolates and antimicrobial susceptibility studies.
        Emerg Microbes Infect. 2018; 7: 61
        • O'Neal M.
        • Labay C.E.
        • Harris J.E.
        • Musick W.L.
        • Cernoch P.L.
        • Grimes K.A.
        • et al.
        Extensively drug-resistant Myroides odoratus in critically ill patients: a case series and literature review.
        Case Rep Infect Dis. 2022; 20226422861
        • Cosgrove S.E.
        • Sakoulas G.
        • Perencevich E.N.
        • Schwaber M.J.
        • Karchmer A.W.
        • Carmeli Y.
        Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.
        Clin Infect Dis. 2003; 36: 53-59
        • Schwaber M.J.
        • Carmeli Y.
        Mortality and delay in effective therapy associated with extended-spectrum β-lactamase production in Enterobacteriaceae bacteraemia: a systematic review and meta-analysis.
        J Antimicrob Chemother. 2007; 60: 913-920