What is Pantoea Agglomerans
Pantoea agglomerans is a gram-negative, aerobic/facultative anaerobic bacillus commonly found in plants, soil, and the environment that causes rare opportunistic infections in humans, primarily through plant-related trauma or as a nosocomial pathogen. 1, 2, 3
Organism Characteristics
- Environmental bacterium associated with plants, soil, food, and feces 2, 3
- Gram-negative rod-shaped bacillus with aerobic and facultative anaerobic properties 1, 3
- Not an obligate human pathogen but capable of causing opportunistic infections 2
- Listed among organisms causing infective endocarditis in the American Heart Association guidelines 4
Routes of Human Infection
Community-Acquired (Plant-Related Trauma)
- Wound inoculation from plant thorns, wooden splinters, or other plant material during agricultural work, gardening, or outdoor activities 2, 3
- Penetrating injuries that introduce plant-residing bacteria into deeper tissues 2
- Common clinical manifestations include septic arthritis, synovitis, endophthalmitis, periostitis, endocarditis, and osteomyelitis 2
Hospital-Acquired (Nosocomial)
- Contaminated medical equipment or fluids in hospitalized, often immunocompromised patients 2, 5
- Medical device-associated infections including central venous catheters 5
- Epidemics of nosocomial septicemia with fatal cases have been documented in both adult and pediatric patients 2
Clinical Presentations
Common Infection Types
- Wound infections (35.7% of cases) 5
- Pneumonia (21.4% of cases) - particularly dangerous with high mortality 5
- Urinary tract infections (21.4% of cases) 5
- Bacteremia and septicemia in immunocompromised hosts 1, 2
- Soft tissue abscesses including rare head and neck manifestations 3
High-Risk Populations
- Immunocompromised patients including those with diabetes, malignancies, or receiving immunosuppressive therapy 1, 2, 5
- Pediatric patients with underlying comorbidities 5
- Patients with indwelling medical devices 5
Treatment Approach
Immediate Management
- Remove infected medical devices when present, as device-associated infections often require removal for cure 5
- Obtain cultures from blood and infected sites before initiating antibiotics 1, 5
Antibiotic Therapy
- Ceftriaxone has demonstrated successful treatment outcomes in documented cases 1
- Cefepime has in vitro activity against Enterobacter agglomerans (a related species) 6
- Carbapenem resistance has been documented and is associated with treatment failure and mortality 5
- Most cases respond favorably to appropriate antibiotics even in immunocompromised patients when treated promptly 1, 2
Duration and Monitoring
- Continue therapy until clinical resolution and negative repeat cultures 1
- Hospital-acquired infections detected after the first week of hospitalization carry worse prognosis, particularly pneumonia cases 5
- Concomitant infections occur in approximately 21% of cases and require broader coverage 5
Critical Clinical Pitfalls
- Do not dismiss as contaminant - while uncommon, P. agglomerans can be a true pathogen requiring targeted therapy, particularly in immunocompromised patients 2, 5
- Recognize carbapenem resistance - hospital-acquired strains may be multidrug-resistant with significantly higher mortality 5
- Pneumonia cases require aggressive treatment - respiratory infections with P. agglomerans are life-threatening, especially when carbapenem-resistant 5
- Obtain detailed exposure history - retrospective identification of plant trauma or environmental exposure may be the key diagnostic clue 3
- Monitor for treatment failure - ineffective antibiotic therapy in pneumonia cases has resulted in death 5