A Case of Nosocomial Outbreak of Pantoea agglomerans Related to Parenteral Nutrition Procedures

Abstract

Pantoea agglomerans is a Gram-negative bacterium that infrequently infects humans. Most reports involving it are about infections in soft tissues or bone/joint infections caused by contamination from soil or penetrating trauma by vegetation, such as thorns and splinters. More frequently, it is found as an opportunistic pathogen in immunocompromised patients. It is not rare to find reports of bacteremia and sepsis from contamination of intravenous fluid, parenteral nutrition, blood products and anesthetic agents—that is, through contamination of medical devices and products. We reported a bacterial infection epidemic occurred in 2011 in a hospital in middle Italy which involved different hospital wards; Pantoea agglomerans was isolated from blood cultures of all infected patients and the source of infection was identified in contaminated parenteral nutrition prepared from the local pharmacy.

Pantoea agglomerans: A rare infectious outbreak affecting maintenance hemodialysis patients in a tertiary care hospital

“…In contrast, none of the patients in our dialysis unit had a recent history of thorn injuries. In concordance with our study findings, published data 2,5 also suggest a high predisposition of this infection in immunocompromised patients as seen by this infectious outbreak, predominantly in our dialysis patients who were diabetics, on immunosuppressives and with prior kidney transplantation. Published data have also suggested that past antibiotic exposure 2,29,30 can increase the risk of this infection.…”

“…However, it has the potential to cause even life-threatening complications such as sepsis, abscess, 17 infective endocarditis, pneumonia, 18 urinary tract infection, 18 septic arthritis, 19 neutropenic fever, 20 endophthalmites, 21 osteomyelitis, 22 and periostitis. 5 In hemodialysis patients, one study reported infective endocarditis of the mitral valve as a predominant complication associated with this infection. 3 Currently, there are limited studies on the occurrence of P. agglomerans infections in the dialysis population, with most focusing on peritonitis in peritoneal dialysis patients.…”

“…It is an opportunistic pathogen primarily affecting immunocompromised individuals 2,5 such as patients with malignancies, 6,7 chronic renal insufficiency, valvular heart disease, and chronic transplant recipients 8,9 . In addition to this, contamination of various medical products such as intravenous fluids, 10 blood, 11 parenteral nutrition solution, 5 anesthetic agents, 12 and anticoagulants 13 have also been reported as sources of infection.…”

“…It is an opportunistic pathogen primarily affecting immunocompromised individuals 2,5 such as patients with malignancies, 6,7 chronic renal insufficiency, valvular heart disease, and chronic transplant recipients 8,9 . In addition to this, contamination of various medical products such as intravenous fluids, 10 blood, 11 parenteral nutrition solution, 5 anesthetic agents, 12 and anticoagulants 13 have also been reported as sources of infection. One of the major outbreaks of this infection occurred in the United States between 1970 and 1971, where 152 cases were infected, resulting in a 13.9% death rate caused by contaminated screwcaps of bottles of parenteral fluids 14 …”

“…P. agglomerrans infection in humans is typically mild and can manifest as localized or generalized infections. However, it has the potential to cause even life‐threatening complications such as sepsis, abscess, 17 infective endocarditis, pneumonia, 18 urinary tract infection, 18 septic arthritis, 19 neutropenic fever, 20 endophthalmites, 21 osteomyelitis, 22 and periostitis 5 . In hemodialysis patients, one study reported infective endocarditis of the mitral valve as a predominant complication associated with this infection 3 …”