On August 12th, 2018, a 46-year-old female patient was admitted to the emergency ward of the People's Hospital (Longyan, China) due to severe trauma caused by the collapse of a brick kiln. She had no history of any chronic or infectious diseases earlier. An initial physical examination found that her vital signs were stable and within normal range. She was still conscious but with limited activity. Further examination revealed that her whole body was burned with blisters (2% of the abdomen, 3% of the right waist, 4% of the back, 7% of the legs, and 2% of the arms). Her right eyelid was turned and exploited, while her left forehead skin and labium were exuded with blood because of the contusion. The back side of her left hand was injured, with exposure of bones and tendons. Her iliac region was also swollen with skin bruises and congestion, she felt obvious pain, and her pelvic extrusion and separation tests were positive. An emergency computer tomography (CT) of her brain, chest, and abdomen was recommended. Chest CT showed mild dilation in the right middle lobe, the right lower lobe, and the left lower lobe (Figure 1). Blood analysis showed a white blood cell (WBC) count of 8.13x109/L, hemoglobin (HGB) of 130g/L, and platelet (PLT) count of 174 x109/L. After clinical examination and imaging studies, she was diagnosed to have multiple fractures (right sacral promontory, bilateral superior pubic ramus, right inferior pubic ramus, right 1-5th rib), multiple lacerations (scalp, right canthus, right eyelid), acute traumatic craniocerebral injury, superficial skin contusion (right zygomatic, left frontal), and multiple burns (II , 18% of the total body surface area [TBSA]). A comprehensive treatment of debridement, analgesics, anti-infection (levofloxacin 0.4 QD+ cefazolin 1.0 Q12H, I.V.), hemostasis, tetanus prevention, wound exposure, and rehydration was carried out on the first day. On hospital day 2, her blood pressure dropped to 85/50mmHg, and HGB reached a nadir of 104g/L. We suspected the patient was in a state of hemorrhagic shock due to intra-abdominal hemorrhage and pelvic fracture and transferred her to the intensive care unit (ICU) immediately. She received enhanced dilatation and rehydration treatment, anti-infection (ceftazidime 1.0 Q8H + levofloxacin 0.4 QD, I.V. for 11 days), analgesia, nutritional support, single room isolation, appropriate braking, wound disinfection, external application of burn cream, and exposure treatments. Her situation improved gradually, with stable blood pressure. But she had an intermittent moderate fever (38.2 C of the highest level) without any symptoms of respiratory or urinary tract infection. There was still much exudation from the wound on her back and upper right leg. Bilateral blood samples were collected to culture both aerobic and anaerobic bacteria on the 7th day. Her blood analysis still showed a normal WBC count of 3.75x109/L, an elevated CRP of 145 mg/L, and a mildly elevated PCT of 0.81 ng/mL. Four days later, her first blood culture reports revealed the presence of bacterial Pandoraea species (Figure 2). In vitro susceptibility testing with the Vitek2 compact system (bioMerieux, Marcy-I'Etoile, France): interpreted according to the 2018 Clinical and Laboratory Standards Institute (CLSI) criteria for non-fermentative isolates: showed the isolate to be only sensitive to sulfamethoxazole, imipenem, and ampicillin/sulbactam (Table 1). On hospital day 12, her body temperature rose to a higher level of 38.9 C. The second bilateral blood sample for bacterial culture was collected again. Repeat blood analysis still showed a normal white blood cell count of 4.21x109/L, an elevated C-reactive protein (CRP) of 93.7 mg/L, and mildly elevated procalcitonin (PCT) of 0.74 ng/mL. A repeat CT scan of the chest and abdomen showed no new pulmonary shadows but still obvious soft tissue edema and subcutaneous swelling in the right abdominal wall and the right iliac region. The bacterial Pandoraea species presented in her blood was considered the responsible pathogen for her infection. On hospital day 13, we changed her anti-infection treatment to imipenem 1.0 Q8H + tigecycline 50 mg Q12H I.V. Four days later, her second blood culture reports again confirmed the presence of Pandoraea species, which were sensitive to the three antibiotics mentioned above and minocycline (Table 1). The source of her sepsis was presumed to be wound-associated, as no respiratory or urinary infection happened during the hospital day. On day 18, bacteria culture and the high-throughput gene detection of pathogenic microorganisms were performed using the samples from her wound secretion. Although the results of high-throughput gene sequencing of pathogenic microbial DNA only showed DNA sequences of Staphylococcus epidermidis and Candida parapsilosis, Pandoraea species was again cultured six days after sample collection (Table 1). 16S ribosomal RNA (rRNA) gene sequencing of bacteria from her first blood culture sample confirmed it as Pandoraea species, which has the first-highest similarity to Pandoraea sputorum (99.89%), the second-highest similarity to Pandoraea vervacti (99.66%), and the third-highest similarity to Pandoraea oxalalivorans (99.66%). The MALDI-TOF MS method was further applied to confirm it as Pandoraea sputorum. No bacteria were isolated from her blood sample collected on the hospital days 17th and 23rd. After 14 days of treatment with appropriate anti-infection and wound care, the patient's condition improved with a normal body temperature, a normal CRP of 6.0mg/L, a normal PCT of 0.11ng/mL, and scanty wound exudation (Figure 3). Her situation was stable enough to shift her to the Department of Burn and Plastic Surgery to continue her wound reparation. Two months later, she was discharged from our hospital, her wounds and fractures healed, and she could move freely. The clinical manifestations, significant examination results, and related antibiotic treatments have been presented as a timeline (Figure 4).