Endophthalmitis caused by Pantoea agglomerans: clinical features, antibiotic sensitivities, and outcomes

Figures & data

Figure 1 Growth of Pantoea agglomerans on a blood agar culture plate.

Notes: The yellow color of the growing colonies is characteristic of P. agglomerans. These colonies were grown from the vitreous sample from patient number 2.

Table 1 Presentation, Tx strategies, and outcomes of patients with endophthalmitis caused by Pantoea agglomerans

Patient number	Age (years)	Eye	Sex	Clinical setting	Initial BCVA	Hypopyon	IOP	Initial Tx	Initial intravitreal injections	Additional Tx (days after initial Tx)	Last BCVA	Follow-up time (months)
1	72	OD	F	Post-ECCE surgery (3 weeks)	HM	Yes	6	PPV	VANC + GENT + CFX	None	20/200	5
2	10	OD	M	Penetrating trauma (tree branch)	LP	No	UKN	PPV	VANC + CFT	None	20/400	52
3	14	OS	M	Penetrating trauma (rock)	LP	No	23	T + I	VANC + CFT	PPV, VANC + GENT (1)	NLP	2

Abbreviations: BCVA, best-corrected visual acuity; CFT, ceftazidime (2.25 mg/0.1 mL); CFX, ceftriaxone (2 mg/0.1 mL); ECCE, extracapsular cataract extraction; F, female; GENT, gentamicin (200 μg/0.1 mL); HM, hand motion; IOP, intraocular pressure; LP, light perception; M, male; NLP, no light perception; OD, right eye; OS, left eye; PPV, pars plana vitrectomy; T + I, tap and injection; Tx, treatment; UKN, unknown; VANC, vancomycin (1 mg/0.1 mL).

Table 2 Antibiotic resistance of Pantoea agglomerans isolates

Antibiotic	Resistant isolates (number tested)	Minimal inhibitory concentration ug/mL
		Patient 1	Patient 2	Patient 3
Beta-lactams
Ampicillin	3 (3)	32	32	32
Aztreonam	0 (2)	–	8	8
Cefotaxime	0 (2)	4	32	–
Ceftazidime	0 (3)	8	8	8
Ceftriaxone	0 (2)	–	8	8
Imipenem	0 (2)	–	4	4
Fluoroquinolones
Ciprofloxacin	0 (3)	0.5	0.5	0.5
Levofloxacin	0 (2)	–	0.5	1
Aminoglycosides
Amikacin	0 (2)	–	2	2
Gentamicin	0 (3)	0.5	1	0.5
Tobramycin	0 (3)	0.5	0.5	0.5

Table 3 Comparison of patient presentation, initial treatment, and visual acuity outcomes between this study and all other reported cases in the literature

	Current study January 1990 – December 2012 P. agglomerans (n=3)	Previously reported cases^Citation2^–^Citation7 January 1976 – January 2014 P. agglomerans (n=11)
	Number of patients (%)	Number of patients (%)
Clinical setting
Post-cataract surgery	1 (33)	1 (9)
Traumatic	2 (66)	6 (55)
Endogenous	0 (0)	4 (36)
Initial treatment
Vitreous tap + antibiotics	1 (33)	3 (27)
PPV + antibiotics	2 (66)	8 (73)
Intravitreal corticosteroids	1 (33)	5 (45)
Visual acuity outcomes
≥20/50	0 (0)	4 (36)
≥20/400	1 (33)	3 (27)
<20/400	2 (66)	4 (36)

Abbreviations: P. agglomerans, Pantoea agglomerans; PPV, pars plana vitrectomy.

Table 4 Comparison of antibiotic resistance of Pantoea agglomerans isolates causing endophthalmitis from the United States and Asia

Antibiotic	All US studies^Citation6 (n=4)a	Asian studies^Citation2,Citation3 (n=6)	Total^Citation2,Citation3,Citation6 (n=10)
	Resistant isolates (number tested)	Resistant isolates (number tested)	Resistant isolates (number tested)	Resistant (%)
Beta-lactams
Ampicillin	3 (4)	2 (6)	5 (10)	50
Aztreonam	0 (2)	0 (1)	0 (3)	0
Cefotaxime	0 (2)	0 (1)	0 (3)	0
Ceftazidime	0 (3)	2 (6)	2 (9)	22
Ceftriaxone	0 (2)	1 (5)	1 (7)	14
Imipenem	0 (2)	0 (6)	0 (8)	0
Fluoroquinolones
Ciprofloxacin	0 (3)	0 (1)	0 (4)	0
Levofloxacin	0 (2)	0 (5)	0 (7)	0
Aminoglycosides
Amikacin	0 (2)	0 (6)	0 (8)	0
Gentamicin	0 (4)	0 (6)	0 (10)	0
Tobramycin	0 (3)	0 (1)	0 (4)	0

Notes: Three previously published cases did not publish sensitivities and could not provide them upon request (Zeiter et al,⁷ Kletke et al,⁵ and Seok et al⁴).

a Includes the current US study.

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