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Hassan D, Saleem N, Haneef M, Khan M, Aziz M, Usman M. Pantoea agglomerans: A rare infectious outbreak affecting maintenance hemodialysis patients in a tertiary care hospital. Semin Dial 2024; 37:172-177. [PMID: 37779418 DOI: 10.1111/sdi.13182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 09/08/2023] [Accepted: 09/15/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Pantoea agglomerans is an environmental pathogen known to cause infection in immunocompromised individuals, particularly after thorn injuries. However, previous data showed few cases of human disease caused by contaminated medical products such as parenteral nutrition, anesthetic agents, blood, and peritoneal dialysis solutions. Infection in hemodialysis patients is rare. In this study, we presented a detailed account of several hemodialysis patients infected with this contagious pathogen and compared them with noninfected dialysis patients. METHODS We retrospectively reviewed the hospital records of 105 hemodialysis patients. Seventeen of 105 patients were diagnosed with P. agglomerans infection. We carefully analyzed their entire in-hospital course. RESULTS Among infected patients, 52.9% were male with a median age of 49 (IQR: 32-66) years. Compared to the noninfected patients, age below 50 years, prior kidney transplantation, prior immunosuppression and antibiotics use, and dialysis via a tunneled vascular catheter were the significant epidemiological features. Despite negative microbiological investigations, we suspect the possible infectious spread via infected central venous catheter was the likely infectious source. Most importantly, all patients responded well to intravenous antibiotics. Only two patients required the removal of the tunneled catheter. Their mortality rate was 0%. CONCLUSION P. agglomerans infection, although considered rare, is becoming increasingly prevalent among dialysis patients. Its occurrence must be appraised as an infectious outbreak rather than mere contamination. Prompt treatment, source identification, and early implementation of preventive strategies should always be the goal to curtail this infection at an early stage.
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Affiliation(s)
- Danyal Hassan
- Department of Renal Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Nida Saleem
- Department of Renal Medicine, Shifa International Hospital, Islamabad, Pakistan
- Department of Renal and Transplantation Medicine, Westmead Hospital, Sydney, New South Wales, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Centre for Kidney Research, Kids Research Institute, The Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Muhammad Haneef
- Department of Renal Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Merina Khan
- Department of Renal Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Maliha Aziz
- Shifa Clinical Research Centre, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Usman
- Department of Microbiology, Shifa International Hospital, Islamabad, Pakistan
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Casale R, Boattini M, Bianco G, Comini S, Corcione S, Garazzino S, Silvestro E, De Rosa FG, Cavallo R, Costa C. Bloodstream Infections by Pantoea Species: Clinical and Microbiological Findings from a Retrospective Study, Italy, 2018-2023. Antibiotics (Basel) 2023; 12:1723. [PMID: 38136757 PMCID: PMC10740582 DOI: 10.3390/antibiotics12121723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: The widespread use of MALDI-TOF coupled to mass spectrometry has improved diagnostic accuracy by identifying uncommon bacteria. Among Enterobacterales, Pantoea species have been seen to be implicated in several human infections, but their clinical and microbiological framework is currently based on a few anecdotal reports. (2) Methods: We conducted this five-year (2018-2023) single-center study aimed at investigating the prevalence and clinical and microbiological findings of Pantoea species bloodstream infections. (3) Results: Among the 4996 bloodstream infection Gram-negative isolates collected during the study period, Pantoea species accounted for 0.4% (n = 19) of isolates from 19 different patients, 5 of them being pediatric cases. Among Pantoea species isolates, P. agglomerans was the most frequently detected (45%; n = 9) followed by P. eucrina (30%; n = 6) and P. septica (15%; n = 3). Malignancy (35.7%) in adults and malignancy (40%) and cerebrovascular disease following meconium aspiration (40%) in pediatric patients as comorbidities and shivering and/or fever following parenteral infusion (36.8%) as a symptom/sign of Pantoea species bloodstream infection onset were the most frequently observed clinical features. Among adults, primary bloodstream infection was the most frequent (50%), whereas among pediatric patients, the most commonly identified sources of infection were catheter-related (40%) and the respiratory tract (40%). Overall, Pantoea species bloodstream infection isolates displayed high susceptibility to all the antibiotics except for ampicillin (63.2%), fosfomycin (73.7%), and piperacillin/tazobactam (84.2%). Targeted antibiotic treatment was prescribed as monotherapy for adults (71.4%) and combination therapy for pediatric patients (60%). The most prescribed antibiotic regimens were piperacillin/tazobactam (21.4%) in adults and meropenem- (40%) and aminoglycoside-containing (40%) antibiotics in pediatric patients. The overall 28-day all-cause mortality rate was 5.3% (n = 1). (4) Conclusions: The prevalence and 28-day mortality rate of Pantoea species bloodstream infections were low. The prescription of targeted therapy including broad-spectrum antibiotics could indicate an underestimation of the specific involvement of the Pantoea species in the onset of the disease, warranting further studies defining their pathogenic potential.
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Affiliation(s)
- Roberto Casale
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Matteo Boattini
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
- Lisbon Academic Medical Centre, 1649-028 Lisbon, Portugal
| | - Gabriele Bianco
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Sara Comini
- Operative Unit of Clinical Pathology, Carlo Urbani Hospital, 60035 Jesi, Italy
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy
| | - Silvia Garazzino
- Infectious Diseases Unit, Department of Pediatric and Public Health Sciences, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Erika Silvestro
- Infectious Diseases Unit, Department of Pediatric and Public Health Sciences, Regina Margherita Children’s Hospital, 10126 Turin, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, 10124 Turin, Italy
- Unit of Infectious Diseases, Cardinal Massaia Hospital, 14100 Asti, Italy
| | - Rossana Cavallo
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
| | - Cristina Costa
- Microbiology and Virology Unit, University Hospital City of Health and Science of Turin, 10126 Turin, Italy
- Department of Public Health and Paediatrics, University of Turin, 10124 Turin, Italy
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Merla C, Mileto I, Gaiarsa S, Achille C, Ghirardello S, Corbella M, Baldanti F, Cambieri P. Surveillance in a Neonatal Intensive Care Unit Allowed the Isolation of a Strain of VIM-Producing Pantoea brenneri. Antibiotics (Basel) 2023; 12:antibiotics12010098. [PMID: 36671299 PMCID: PMC9854652 DOI: 10.3390/antibiotics12010098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/07/2023] Open
Abstract
Here, we describe the isolation of a strain of the genus Pantoea encoding a VIM carbapenemase, the first to our knowledge. The strain, isolated from a rectal swab of a 10-day-old newborn admitted to a neonatal intensive care unit (NICU), was identified through whole-genome sequencing analyses as Pantoea brenneri. The strain harbored the carbapenemases gene blaVIM-1. The prompt application of contact measures and the isolation of the newborn prevented the dissemination of VIM-producing P. brenneri and of the plasmid carrying the VIM-1 gene to other newborns.
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Affiliation(s)
- Cristina Merla
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Irene Mileto
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Scuola di Specializzazione in Microbiologia e Virologia, Università degli Studi di Pavia, 27100 Pavia, Italy
| | - Stefano Gaiarsa
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Cristian Achille
- Neonatologia e Terapia Intensiva Neonatale, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Stefano Ghirardello
- Neonatologia e Terapia Intensiva Neonatale, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Marta Corbella
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Correspondence:
| | - Fausto Baldanti
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Clinical: Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, 27100 Pavia, Italy
| | - Patrizia Cambieri
- UOC Microbiologia e Virologia, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Mustapha SS, Ibrahim M, Aliyu S, Abdulkadir I. Enterobacter agglomerans, an uncommon cause of community-acquired bacterial infection in neonates. J Trop Pediatr 2022; 68:6760803. [PMID: 36228308 DOI: 10.1093/tropej/fmac085] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Enterobacter agglomerans formerly termed Erwina herbicola but now called Pantonea agglomerans is a ubiquitous gram-negative bacterium that rarely causes mild and opportunistic infection in humans. Sources of infection are myriad causing both local and systemic disease across all systems of the body. Infection is often fulminant and fatal in neonates. We aim to report another facet of the infection as seen in our centre. Of the 248 neonates recruited into the study, 94 had bacteria isolated from their blood, eight (8.5%) of whom had E. agglomerans sepsis. Infection was acquired from the community though its source could not be determined. The clinical features were non-specific running a mild course. Toxic granulation, elevated immature polymorph count and procalcitonin level was found in 50% and 75% of the neonates. Isolate was sensitive to most tested antibiotics, showing 100% sensitivity to gentamicin and ciprofloxacin and the survival rate was excellent (87.5%).
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Affiliation(s)
| | - Mohammed Ibrahim
- Department of Medical Microbiology, Immunology Federal Teaching Hospital, Gombeand, Zaria
| | - Shamsudin Aliyu
- Department of Medical Microbiology, Ahmadu Bello University, Zaria
| | - Isa Abdulkadir
- Department of Paediatrics, Ahmadu Bello University, Zaria, Zaria
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