Sphingomonas paucimobilis bloodstream infection is a predominantly community-onset disease with significant lethality

•Sphingomonas paucimobilis bloodstream infection is a predominantly community-onset disease.•More than 1 in 20 cases of Sphingomonas paucimobilis are fatal.•The incidence of Sphingomonas paucimobilis bloodstream infection was highest in tropical north Queensland. Small case series and reports suggest that Sphingomonas paucimobilis is predominantly a cause of nosocomial bloodstream infections (BSI) with very low associated mortality. Our objective was to describe the epidemiology and outcome of Sphingomonas species BSI in a large Australian population. We included all residents of Queensland, Australia, with BSI because of Sphingomonas species identified within the publicly funded system from 2000 to 2019. A total of 282 incident episodes of Sphingomonas species BSI were identified for an age- and sex-adjusted incidence of 3.2 per million population annually. Incidence rates were highest in the tropical regions of the state. Most (94%) of the isolates were confirmed as Sphingomonas paucimobilis. In addition, 77% of the infections were community-onset, of which 48% were community-associated, and 30% were healthcare-associated. The very young, the old, and male patients were at the highest risk. Patients with community-associated disease were, on average, younger, had fewer co-morbidities, and were less likely to have polymicrobial infections. At least 1 co-morbidity was identified in 62% of patients, with malignancy, diabetes, and lung disease most prevalent. The overall all-cause 30-day case-fatality rate was 6%. Sphingomonas paucimobilis BSI is a predominantly community-onset disease associated with a significant risk of death.