Treatment of Pantoea Species from Wound Culture
For Pantoea species infections in wounds, treatment should include appropriate wound debridement followed by targeted antibiotic therapy based on culture and susceptibility testing, with fluoroquinolones or third-generation cephalosporins being first-line options for most cases. 1, 2
Diagnostic Approach
Before initiating treatment, proper specimen collection is essential:
- Cleanse and debride the wound before obtaining specimens for culture 3
- Obtain deep tissue specimens by curettage, biopsy, or aspiration rather than surface swabs 3
- Send specimens promptly for aerobic and anaerobic culture 3
Treatment Algorithm
Step 1: Wound Management
- Perform thorough debridement of infected tissue 3
- Remove any foreign material, especially plant matter which is commonly associated with Pantoea infections 1
- Consider surgical drainage for abscesses or deep-seated infections 3
Step 2: Empiric Antibiotic Therapy
While awaiting culture results:
For mild to moderate infections:
For severe infections:
Step 3: Targeted Therapy Based on Culture Results
Pantoea species generally show high susceptibility to:
- Fluoroquinolones
- Third-generation cephalosporins
- Carbapenems
- Aminoglycosides
- Trimethoprim-sulfamethoxazole
Lower susceptibility is typically seen with:
- Ampicillin (63.2% susceptibility)
- Fosfomycin (73.7% susceptibility)
- Piperacillin-tazobactam (84.2% susceptibility) 2
Step 4: Treatment Duration
- For soft tissue infections without complications: 1-2 weeks for mild infections, 2-3 weeks for moderate to severe infections 3
- Continue antibiotics until clinical signs of infection have resolved but not through complete wound healing 3
Special Considerations
Risk Factors for Pantoea Infections
- Penetrating trauma with plant material or wooden splinters 1, 4
- Immunocompromised status 1
- Presence of indwelling catheters 4
- Agricultural or gardening occupations 1
Clinical Manifestations
Pantoea infections can present as:
- Wound infections
- Septic arthritis or synovitis
- Abscesses
- Bacteremia (especially catheter-related)
- Osteomyelitis 1, 4
Common Pitfalls and Caveats
Misidentification: Pantoea species can be misidentified by conventional methods; MALDI-TOF mass spectrometry or 16S rRNA sequencing may be needed for accurate identification 2, 5
Underestimation of pathogenicity: Despite being considered opportunistic pathogens, Pantoea species can cause serious infections, especially in immunocompromised hosts 1
Inadequate debridement: Failure to thoroughly debride infected tissue and remove foreign material (especially plant matter) can lead to persistent infection 3, 1
Premature discontinuation of antibiotics: Continue treatment until all clinical signs of infection have resolved 3
Overlooking polymicrobial nature: Pantoea infections, especially those related to plant material, may be polymicrobial and require broader coverage 3