A Rare Pathogen in a Burn Patient: Pantoea agglomerans

Children with burn injuries are prone to increased risk for infection. Pantoea agglomerans is a particularly uncommon microorganism related to burn wound infections. A previously healthy, 28-month-old-boy was admitted with scald due to hot water. His general condition was moderate with normal vital signs. He had full thickness (right anterior forearm, 1.5%) and partial thickness (upper part of left arm, 0.5%; left anterior forearm, 2%; right thigh, 1%; right leg, 0.5%; left thigh, 0.5%; and left leg, 1%) burn wounds with totally estimated surface area percentage of 7%. Laboratory findings (hemogram, C-reactive protein, erythrocyte sedimentation rate, and blood biochemistry) were unremarkable. As well as hemodynamic stabilization and nutritional support, daily dressing with silver sulfadiazine was performed. Ten days later, grafting was carried out as the wound on right anterior forearm did not heal. Prophylactic intravenous cefazolin treatment (50mg/kg/day) was started. Four days after operation, he had 38.8°C fever and wound infection was realized. Gram stain of the swab revealed gram negative rods. Antibiotic treatment changed to ceftriaxone (75 mg/kg/day). While blood culture was negative, swab culture grew Pantoea agglomerans, resistant to cefazolin, sensitive to ceftriaxone. His fever subsided after 24 hours of ceftriaxone treatment and he was discharged on the 10th day. His immunological investigation was normal. One week later on control examination, his lesion was epithelized. Burn wound infections in pediatric age group can be caused by rare organisms. Other than presence of immunodeficiency, a graft tissue may ease this situation.