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

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Antimicrobial Resistance

Background:

• Pandoraea species are Gram-negative, non-fermenting bacteria causing infections in vulnerable patients.
• These pathogens exhibit intrinsic multi-drug resistance (MDR), posing treatment challenges.

Purpose of the Study:

• To review current knowledge on Pandoraea infections and antimicrobial susceptibility.
• To guide clinicians in selecting effective therapeutic strategies for Pandoraea infections.

Main Methods:

• Comprehensive literature search of PubMed/MEDLINE/Google Scholar and expert microbiology texts.
• Analysis of antimicrobial resistance patterns and treatment options for Pandoraea isolates.

Main Results:

• Pandoraea isolates show frequent resistance to common antibiotics like beta-lactams, aminoglycosides, fluoroquinolones, and polymyxins.
• Many strains remain susceptible to imipenem (IMP) due to specific OXA beta-lactamases (OXA-1152), despite meropenem resistance.
• Imipenem (IMP) and trimethoprim-sulfamethoxazole (SXT) are identified as the most active agents.

Conclusions:

• Limited robust clinical data exist for Pandoraea infections, highlighting a knowledge gap.
• Imipenem (IMP) and trimethoprim-sulfamethoxazole (SXT) are recommended as primary or combination therapy options.
• Further research is needed to establish evidence-based treatment guidelines for Pandoraea infections.