Compassionate Use of Cefiderocol in the Treatment of an Intraabdominal Infection Due to Multidrug-Resistant Pseudomonas aeruginosa: A Case Report.

IF 1.8 Q3 COMPUTER SCIENCE, ARTIFICIAL INTELLIGENCE
Foundations of Computing and Decision Sciences Pub Date : 2019-11-01 Epub Date: 2019-10-22 DOI:10.1002/phar.2334
Ryan W Stevens, Megan Clancy
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引用次数: 35

Abstract

Multidrug-resistant (MDR) Pseudomonas aeruginosa infections often represent a therapeutic challenge requiring utilization of older, more toxic antibiotics, or new agents with limited data. Once susceptibility to β-lactam and fluoroquinolone antibiotics has been lost, other therapeutic options such as aminoglycoside or polymyxin antibiotics carry significant adverse effects such as nephrotoxicity, neurotoxicity, and ototoxicity. A novel cephalosporin, cefiderocol, lacks gram-positive and anaerobic activity but offers broad coverage of gram-negative bacteria, including P. aeruginosa. A unique catechol side chain gives it activity as a siderophore, thereby increasing bacterial uptake and decreasing efflux. Additionally, cefiderocol is stable against a wide array of β-lactamases. Despite these promising characteristics, there are minimal data currently available in the literature detailing the use of cefiderocol in the treatment of MDR P. aeruginosa infections. We present a case of a 46-year-old man who developed an MDR P. aeruginosa intraabdominal infection where serious and life-threatening toxicities to aminoglycosides and polymyxin antibiotics led to the utilization of cefiderocol on compassionate use approval. The isolate was susceptible to cefiderocol, and the patient was treated for 28 days of therapy. He demonstrated clinical and radiographic resolution of his infection and was discharged to home.

在治疗耐多药性铜绿假单胞菌引起的腹腔感染时同情使用头孢羟氨苄:病例报告。
耐多药(MDR)铜绿假单胞菌感染通常是一种治疗难题,需要使用毒性更大的老抗生素或数据有限的新药。一旦对β-内酰胺类和氟喹诺酮类抗生素失去敏感性,氨基糖苷类或多粘菌素类抗生素等其他治疗选择就会带来明显的不良反应,如肾毒性、神经毒性和耳毒性。新型头孢菌素 cefiderocol 缺乏对革兰氏阳性菌和厌氧菌的活性,但可广泛用于革兰氏阴性菌,包括铜绿假单胞菌。独特的儿茶酚侧链使其具有苷酸活性,从而增加细菌的吸收,减少外流。此外,头孢羟氨苄对多种β-内酰胺酶都很稳定。尽管头孢羟氨苄具有这些良好的特性,但目前文献中关于头孢羟氨苄用于治疗 MDR 铜绿葡萄球菌感染的详细数据极少。我们介绍了一例 46 岁男性的 MDR 铜绿假单胞菌腹腔内感染病例,该患者对氨基糖苷类和多粘菌素类抗生素产生了严重且危及生命的毒性反应,因此在获得同情使用批准后使用了头孢羟氨苄。分离出的菌株对头孢羟氨苄敏感,患者接受了 28 天的治疗。他的感染在临床和影像学上都得到了缓解,并已出院回家。
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来源期刊
Foundations of Computing and Decision Sciences
Foundations of Computing and Decision Sciences COMPUTER SCIENCE, ARTIFICIAL INTELLIGENCE-
CiteScore
2.20
自引率
9.10%
发文量
16
审稿时长
29 weeks
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