What treatment options are available for Pantoea agglomerans infections with resistance to all antibiotics?

From the Guidelines

For Pantoea agglomerans that is resistant to all antibiotics, consider combination therapy with ceftolozane/tazobactam or ceftazidime/avibactam as a last resort option, as these antibiotics have shown efficacy against multidrug-resistant gram-negative bacteria 1. Consult with an infectious disease specialist immediately for personalized guidance. Laboratory testing for synergy between antibiotics may help identify effective combinations. In severe cases, surgical debridement of infected tissue may be necessary alongside antimicrobial therapy. Supportive care and close monitoring of organ function are essential. Infection control measures should be implemented to prevent spread. Pantoea agglomerans is an opportunistic gram-negative bacterium that can cause serious infections, particularly in immunocompromised patients. Pan-resistant strains are rare but concerning, as they have developed mechanisms to inactivate or expel multiple classes of antibiotics. Early and aggressive intervention with expert consultation offers the best chance for successful treatment.

Some key points to consider in the treatment of Pantoea agglomerans infections include:

• The use of broad-spectrum antibiotics, such as carbapenems, should be limited to preserve their activity against multidrug-resistant bacteria 1.
• Combination therapy with aminoglycosides, such as amikacin, may be effective against gram-negative bacteria, but their use should be cautious due to potential toxic side effects 1.
• New antibiotics, such as ceftolozane/tazobactam and ceftazidime/avibactam, have shown promise in treating multidrug-resistant gram-negative infections, including those caused by ESBL-producing Enterobacteriaceae and P. aeruginosa 1.
• Surgical debridement and supportive care may be necessary in severe cases, and infection control measures should be implemented to prevent the spread of pan-resistant strains.

It is essential to note that the treatment of Pantoea agglomerans infections should be individualized and based on the patient's specific condition, the severity of the infection, and the results of antimicrobial susceptibility testing. Consultation with an infectious disease specialist is crucial to ensure the best possible outcome. The use of antibiotics should always be guided by the principles of antimicrobial stewardship, and efforts should be made to minimize the development of resistance and preserve the efficacy of available antibiotics.

In terms of specific treatment regimens, the choice of antibiotics and the duration of therapy will depend on the severity of the infection, the patient's underlying health status, and the results of antimicrobial susceptibility testing. In general, combination therapy with a broad-spectrum antibiotic, such as ceftolozane/tazobactam or ceftazidime/avibactam, and an aminoglycoside, such as amikacin, may be effective against multidrug-resistant gram-negative bacteria. However, the use of these antibiotics should be cautious, and their efficacy and safety should be closely monitored. The duration of therapy will depend on the severity of the infection and the patient's response to treatment, but it is generally recommended to continue antibiotics for at least 5-7 days, or until the patient has shown significant clinical improvement.

Overall, the treatment of Pantoea agglomerans infections requires a comprehensive approach that includes antimicrobial therapy, supportive care, and infection control measures. Early and aggressive intervention with expert consultation offers the best chance for successful treatment, and efforts should be made to minimize the development of resistance and preserve the efficacy of available antibiotics.

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.