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

<i>Pandoraea</i> 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 <i>Pandoraea</i> infections on PubMed/MEDLINE/Google Scholar and books written by experts in microbiology and infectious diseases. <i>Pandoraea</i> 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 <i>Pandoraea</i> 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 <i>Pandoraea</i> 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.