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Authors

Agaliadou-Dioritou U.
Aslanidis Th.
Karakosta P.

DOI

The Greek E-Journal of Perioperative Medicine 2019;18(b): 39-42

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EN

POSTED: 09/25/19 8:12 PM
ARCHIVED AS: 2019, 2019b, Case Reports
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DOI: The Greek E-Journal of Perioperative Medicine 2019;18(b): 39-42

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Authors: Karakosta P. MD, Agaliadou-Dioritou U. MD, PhD, Aslanidis Th. MD, PhD.

Intensive Care Unit, St. Paul General Hospital, Thessaloniki, Greece

 

ABSTRACT

We present a case report concerning fatal bacteremia caused by Pantoeaagglomerans in a critically ill patient.

INTRODUCTION

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.

CASE REPORT

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.

DATE BACTERIA SOURCE WBC CPR PCT ANTIBIOTIC MIC
04/02/2019 19.4 12.7 0.2 moxifloxacin Emp.th
clarithromycin Emp.th
08/02/2019 Ac.baum. bs 53.3 40.6 17.5 colistin <0.5
Ac.baum. blood colistin <0.5
teicoplanin Emp.th
20/02/2019 Ac.baum. blood 17.1 2.3 0.4 colistin <0.5
Stlugd blood
E.faecalis blood linezolid 2
21/02/2019 Ac.baum. bs 15.63 2.7 0.19 colistin <0.25
25/02/2019 M morg blood 14.08 8.8 0.34 meropenem <0.25
Psaer cvc
Ac.baum. cvc
27/02/2019 Psaer(MBL) bs 10.9 10.7 0.8 colistin <0.5
Ac.baum. bs colistin <0.5
03/03/2019 Prst cvc 7.9 34 1.27
St. haem cvc voncon 1
06/03/2019 St. haem blood 7. 16 0.99 voncon 1
15/03/2019 Pr. mir. bs 8.99 11.3 0.34 amikacin <2
Prst bs amikacin <2
21/03/2019 Kl. pn. 13.5 5 0.21 amikacin <2
 22/03/2019 Ps.aer/Ac.bau bs 16.02 8 0.24 colistin <0.25
Ac.baum. cvc
27/03/2019 Psaer(MBL) bs 14.200 15.3 0.61 colistin <0.5
15/04/2019 Prst bs 15.100 18 0.49 aztreonam 2
Ac.baum. meropenem <0.25
27/04/2019 Ac.baum. p ulcer 11430 5.8 0.5 colistin <0.5
Kl. pn. p ulcer gentamicin <1
02/05/2019 Ac.baum. cvc 11820 15.3 0.29 colistin <0.5
tigecycline 8
09/05/2019 Pantoeaspp. blood 9.690 13.6 0.21 ciprofloxacin <0.25

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.

References

  1. Cruz AT, Cazacu AC, Allen CH. Pantoeaagglomerans, a plant pathogen causing human disease. J Clin Microbiol. 2007;45(6):1989-92.
  2. Dutkiewicz J, Mackiewicz B,  Lemieszek, M, et al. Pantoeaagglomerans: A mysterious bacterium of evil and good. Part III. Deleterious effects: Infections of humans, animals and plants. Ann Agric Environ Med 2016; 23(2):197-205.
  3. Segado-Arenas A, Alonso-Ojembarrena A, Lubián-López SP, et al. Pantoeaagglomerans: a new pathogen at the neonatal intensive care unit?ArchArgentPediatr. 2012;110(4):e77-9.
  4. Panknin HT. An outbreak of fatal pantoea infections in newborn infants, caused by contaminated infusion solutions.Kinderkrankenschwester. 2006; 25(5):189-90.
  5. Kurşun O, Unal N, Cesur S, et al.  A case of ventilator-associated pneumonia due to Pantoeaagglomerans. Mikrobiyol Bul. 2012; 46(2): 295–298 (in Turkish).
  6. Izzo I, Lania D, Castro A, et al. Seven cases of port-a-cath contamination caused by Pantoeaagglomerans in the Oncological Service of Iseo Hospital, Brescia (Italy). Infez Med. 2014; 22(2): 152–155.
  7. Asai N, Koizumi Y, Yamada A, et al. Pantoeadispersabacteremia in an immunocompetent patient: a case report and review of the literature. J Med Case Rep. 2019;13(1):33.
  8. Panditrao M, Panditrao M. Pantoeadispersa: Is it the Next Emerging «Monster» in our Intensive Care Units? A Case Report and Review of Literature. Anesth Essays Res. 2018 ;12(4):963-966.

 

 

Author Disclosures:

Authors Karakosta P., Agaliadou-Dioritou U. and Aslanidis Th. have no conflicts of interest or financial ties to disclose.

 

Corresponding author:

Paschalia Karakosta,

3 Viopoulou str , PC 55132,
Thessaloniki,Greece.
tel: +306945491151,
email:pas.karakosta@yahoo.gr

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