Weissella Confusa Infections and Strain-Level Biosafety: Clinical Evidence and Intrinsic Vancomycin Resistance
Abstract
Weissella confusa is an emerging opportunistic pathogen increasingly implicated in invasive infection among immunocompromised individuals, while selected strains continue to be investigated for probiotic applications-creating an inherent tension between beneficial use and infection risk. This is the first systematic synthesis of 39 published cases of invasive W. confusa infection. In this review, we analyzed these cases and summarized current evidence regarding epidemiology, diagnostic approaches, antimicrobial susceptibility, therapeutic management, and biosafety implications. Bacteremia (74.4%) and infective endocarditis (10.3%) were the predominant clinical manifestations and occurred mainly in patients with malignancy, prolonged hospitalization, indwelling medical devices, gastrointestinal barrier disruption, or immunosuppression. Accurate identification remains difficult because W. confusa shares phenotypic characteristics with other lactic acid bacteria and exhibits intrinsic resistance to vancomycin, frequently leading to misidentification and delayed effective therapy. Advanced diagnostic methods including MALDI-TOF MS, 16S rRNA sequencing, and whole-genome sequencing are therefore important for definitive identification. Available evidence suggests that pathogenicity is largely host-dependent, although definitive functional genomic evidence remains limited. Clinically effective antimicrobial agents generally include beta-lactams, daptomycin, and linezolid, whereas…
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