Authors: Karakosta P. MD, Agaliadou-Dioritou U. MD, PhD, Aslanidis Th. MD, PhD.
Intensive Care Unit, St. Paul General Hospital, Thessaloniki, Greece
We present a case report concerning fatal bacteremia caused by Pantoeaagglomerans in a critically ill patient.
Pantoea is a genus of Enterobacteriacae Gram-negative bacteria family that includes at least 20 species; mostly isolated in the ecological niches. Data about its role as pathogen are limited1.
Α 65 year old female, was admitted to our Intensive Care Unit (ICU) after developing acute respiratory failure due to septic shock following 4 days hospitalization in internal medicine department for community acquired pneumonia. Her medical history included morbid obesity (BMI 55.1 kg. m-2), smoking (50 pack-years), chronic obstructive pulmonary disease, arterial hypertension and depression; all under medication, however with bad compliance. On admission her Acute Physiology, Age, Chronic Health Evaluation IV score (APACHE IV) score was 129.
During her 107 days ICU hospitalization, the patient developed series of septic episodes with several microorganisms isolated from various samples (Table 1).
Table1. Isolated bacteria during patient’s hospitalization, along with location spotted, selected laboratory results and antibiotic regiment followed.
|Kl. pn.||p ulcer||gentamicin||<1|
WBC: white blood count (k/μL), CPR:C-reactive protein (mg/dl), PCT: procalcitonin (ng/dl), MIC: minimum inhibitory concentration, Ac.baum: Acinetobacter baumanii, St.lugd: Staphylococcus lugdonensis, E.faecalis: Enterococcus faecalis, M.morg: Morganella morganii, Ps.aer: Pseudomonas aeruginosa, Kl.pn: Klebsiella pneumoniae, St.haem: Staphylococcus haemolyticus, Pr.mir: Proteusmirabillis, Pr.st: Providencia stuartii, CVC: central venous catheter, bs: bronchial secretions, p ulcer: pressure ulcer, Emp.th: empiric therapy.
Antibiotic and supportive therapy strategy followed, managed successfully all spotted infections; yet, the patient died 9 days after Pantoeaagglomerans bacteremia and even though antibiogram revealed a sensitive strain. Concurrent laboratory examination for any possible medical equipment Pantoea contamination turned out negative.
In most literature reports the clinical course of the hospital-acquired disease was mild and application of the proper antibiotic treatment led to full recovery1. Fatal cases are mainly described with in epidemics of nosocomial septicemia caused by contamination of medical equipment or fluids2. Most of the reports regard pediatric population, especially newborns3-4, while data about similar adult cases are limited5-6. The present case is presumably due to the decline of patients’ immunity caused by underlying disease and/or hospital procedures. Other Pantoeaspp identified as pathogens in adults is Pantoea dispersa7-8.
Nevertheless, in the era of multiresistant bacteria, similar reports alert clinicians about the possibility of more frequent emerge of this type of infections.
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Authors Karakosta P., Agaliadou-Dioritou U. and Aslanidis Th. have no conflicts of interest or financial ties to disclose.
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