From the Guidelines
For Pantoea agglomerans infections with resistance to all antibiotics, combination therapy with colistin or ceftolozane/tazobactam should be considered as a last resort option, as these treatments have shown efficacy against difficult-to-treat infections, including those caused by carbapenem-resistant Pseudomonas aeruginosa, as recommended in the 2022 guidelines for the treatment of infections due to multidrug-resistant organisms 1.
Treatment Options
- Combination therapy with colistin, which has been recommended for the treatment of infections due to carbapenem-resistant Pseudomonas aeruginosa, may be effective against Pantoea agglomerans, as both are gram-negative bacteria with potential similarities in resistance mechanisms 1.
- Ceftolozane/tazobactam is another option, given its efficacy against difficult-to-treat Pseudomonas aeruginosa infections, and could potentially be effective against Pantoea agglomerans based on its broad-spectrum activity 1.
- Consultation with an infectious disease specialist is crucial for personalized guidance, as the treatment of pan-resistant infections requires careful consideration of the patient's clinical condition, the potential for synergistic effects between antibiotics, and the risk of adverse effects.
- Laboratory testing for synergy between antibiotics may help identify effective combinations, although this approach is more experimental and should be guided by expert opinion and the latest research findings.
- In severe cases, surgical debridement of infected tissue may be necessary alongside antimicrobial therapy to control the infection source.
- Supportive care, including close monitoring of organ function and implementation of infection control measures to prevent spread, is essential in the management of pan-resistant infections.
Considerations
- The choice between colistin and ceftolozane/tazobactam should be based on the patient's renal function, as both drugs have nephrotoxic potential, with colistin dose adjustments required based on creatinine clearance 1.
- The duration of treatment should be individualized according to the infection site, source control, underlying comorbidities, and initial response to therapy, with suggested treatment durations ranging from 5 to 14 days 1.
- Given the rarity of pan-resistant Pantoea agglomerans and the limited evidence on its treatment, a conservative approach, prioritizing the patient's safety and the potential for clinical efficacy, is warranted.
From the Research
Treatment Options for Pantoea agglomerans Infections
There are limited studies available that discuss treatment options for Pantoea agglomerans infections with resistance to all antibiotics. However, based on the available evidence, the following treatment options have been used:
- Antibiotic treatment: The use of antibiotics such as ceftriaxone 2, piperacillin/tazobactam 3, and meropenem 3 has been reported in the treatment of Pantoea agglomerans infections.
- Combination therapy: Combination therapy with antibiotics such as meropenem and aminoglycosides has been used in pediatric patients 3.
- Removal of medical devices: In some cases, the removal of medical devices such as central venous lines has been necessary to treat Pantoea agglomerans infections 4.
Antibiotic Resistance
Pantoea agglomerans infections with resistance to all antibiotics have been reported, particularly in cases where the infection is hospital-acquired 4. The available evidence suggests that:
- Carbapenem-resistant P. agglomerans has been detected in some cases, which can be life-threatening, especially in young patients with pneumonia 4.
- High susceptibility to all antibiotics except for ampicillin, fosfomycin, and piperacillin/tazobactam has been observed in Pantoea species bloodstream infection isolates 3.
Clinical Features and Outcomes
The clinical features and outcomes of Pantoea agglomerans infections can vary depending on the underlying comorbidities and the source of the infection. The available evidence suggests that:
- Malignancy and cerebrovascular disease are common comorbidities in adult and pediatric patients with Pantoea species bloodstream infections 3.
- Shivering and/or fever following parenteral infusion are common symptoms of Pantoea species bloodstream infection onset 3.
- The overall 28-day all-cause mortality rate for Pantoea species bloodstream infections is low, at 5.3% 3.