Pandoraea Species Bacteremia in a Neonate: A Case Report

Pandoraea species are rare, nonfermenting Gram-negative bacilli that are increasingly recognized as opportunistic pathogens, particularly in patients with cystic fibrosis. They are often misidentified as Burkholderia or Ralstonia species and pose significant diagnostic and therapeutic challenges due to their variable resistance patterns and the absence of standardized susceptibility breakpoints. We report a case of a seven-day-old term, low-birth-weight neonate who presented with respiratory distress and features of sepsis. Blood cultures grew a nonfermenting Gram-negative organism, initially identified as Burkholderia cepacia. Further testing using automated identification systems confirmed Pandoraea species. The organism demonstrated reduced susceptibility to multiple empiric antibiotics, including meropenem and ceftazidime. In the absence of established interpretive criteria, antimicrobial therapy was guided by phenotypic susceptibility patterns and literature review, and treatment was modified to trimethoprim-sulfamethoxazole and levofloxacin. The patient showed gradual clinical improvement with resolution of clinical and laboratory markers of infection and was eventually discharged. This case highlights the importance of accurate identification of uncommon pathogens, awareness of their unique resistance profiles, and close interdisciplinary collaboration to guide management in the absence of standardized treatment guidelines.