Bacteremia caused by Pantoea agglomerans at a medical center in Taiwan, 2000–2010

• Published in: Journal of microbiology, immunology and infection immunology and infection, 2013-06, Vol.46 (3), p.187-194
• Main Authors: Cheng, Aristine, Liu, Chia-Ying, Tsai, Hsih-Yeh, Hsu, Meng-Shuian, Yang, Chia-Jui, Huang, Yu-Tsung, Liao, Chun-Hsing, Hsueh, Po-Ren
• Format: Article
• Language: English
• Subjects: 16S rRNA gene sequence analysis; Academic Medical Centers; Adult; Aged; Antacids - adverse effects; Antacids - therapeutic use; Antimicrobial susceptibilities; Bacteremia; Bacteremia - diagnosis; Bacteremia - microbiology; Bacteremia - pathology; Enterobacter; Enterobacteriaceae Infections - diagnosis; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Enterobacteriaceae Infections - pathology; Exiguobacterium; Female; Gastroesophageal Reflux - complications; Gastroesophageal Reflux - drug therapy; Humans; Infectious Disease; Male; Medical Education; Middle Aged; Pantoea - classification; Pantoea - genetics; Pantoea - isolation & purification; Pantoea agglomerans; Risk Factors; Taiwan - epidemiology
• ISSN: 1684-1182; 1995-9133
• DOI: 10.1016/j.jmii.2012.05.005

Background/Purpose There are only three case reports of adult patients with spontaneous Pantoea agglomerans bacteremia in the English literature. The aim of this study was to investigate clinical and microbiologic characteristics patients of P agglomerans bacteremia. Methods We studied all adult patients with P agglomerans bacteremia at a medical center from 2000 to 2010. The isolates were identified using two commercial identification systems. Results Of the 18 patients identified, 72% (n = 13) had active gastroesophageal disease treated with antacids. Two-thirds of patients had indwelling central lines and advanced cancers. None of the removed catheter tips yielded P agglomerans and line persistence was not associated with adverse outcomes. Initial disease severity was low, hypotension was uncommon and no patient died of bacteremia. Recurrence of bacteremia occurred in one patient with deep-seated infection. 16srRNA gene sequencing identified only half of the isolates as P agglomerans . The remaining nine isolates were Enterobacter species for six, Pantoea ananatis for two, and Exiguobacterium profundum for one. There were no significant differences between the characteristics of the subgroup molecularly identified as P agglomernas and the overall group characteristics. Eleven (61%) of the 18 isolates were susceptible to cefazolin, six (33%) susceptible to fosfomycin (MIC ≤ 64 mg/ml). Two isolates had colistin MICs ≥ 4 mg/ml. Conclusion Bacteremia caused by P agglomerans is associated with gastroesophageal reflux disease and receipt of antacids. 16srRNA gene sequencing should not be used as the sole basis for its identification and we have highlighted the need for another molecular-based technique to conclusively characterize P agglomerans.