Managing Multidrug-Resistant Pandoraea spp.: current evidence and knowledge gaps

Pandoraea species are emerging Gram-negative non-fermenting pathogens increasingly associated with human infections, particularly in patients with cystic fibrosis, immunocompromised hosts, and critically ill individuals. These bacteria exhibit intrinsic multi-drug resistance (MDR), complicating treatment and management. A comprehensive literature search was conducted to identify relevant studies concerning Pandoraea infections on PubMed/MEDLINE/Google Scholar and books written by experts in microbiology and infectious diseases. Pandoraea isolates frequently demonstrate resistance to the most common antimicrobials, such as β-lactams, aminoglycosides, fluoroquinolones, and polymyxins. Interestingly, many strains retain susceptibility to imipenem (IMP) despite resistance to meropenem due to the production of specific oxacillinase-type β-lactamases (OXA) called OXA-1152. Although robust clinical data are lacking, IMP and trimethoprim-sulfamethoxazole (SXT) are the most active agents and may be considered for empirical or combination therapy. Data on the efficacy of newer antibiotics against Pandoraea spp. are extremely limited and often inconsistent. This lack of strong evidence highlights a significant knowledge gap. A few antibiotic options are appropriate for treating Pandoraea spp. with IMP and SXT, which remains the treatment of choice, as well as in combination in the case of severe infections. This review focuses on a niche topic to support clinicians in selecting appropriate therapeutic decisions without precise evidence-based medicine.