Tazobactam/ceftolozane and tobramycin combination therapy in extensively drug-resistant Pseudomonas aeruginosa infections in severe burn injury: a case report.

IF 1.2 Q4 PHARMACOLOGY & PHARMACY
Yuta Ibe, Ryuichiro Kakizaki, Hirotoshi Inamura, Tomoyuki Ishigo, Yoshihiro Fujiya, Hiroyuki Inoue, Shuji Uemura, Satoshi Fujii, Satoshi Takahashi, Eichi Narimatsu, Masahide Fukudo
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引用次数: 0

Abstract

Background: Combination therapy with tazobactam/ceftolozane (TAZ/CTLZ) and high-dose aminoglycosides has been reported to be efficacious in extensively drug-resistant (XDR)-Pseudomonas aeruginosa infection. However, there are no reports of efficacy in XDR-P. aeruginosa infection for combination therapy with low-dose aminoglycosides and TAZ/CTLZ. Herein, we describe a rare case of severe burn injury patients with persistent bacteremia due to XDR-P. aeruginosa, which was successfully treated with TAZ/CTLZ and low-dose tobramycin (TOB).

Case presentation: A 31-year-old man was admitted to the intensive care unit with severe burn injury involving 52% of the total body surface area and a prognostic burn index of 79.5. The patient had recurrent bacterial infections since admission, and blood cultures collected on the 37th day of admission revealed the presence of P. aeruginosa strains that were resistant to all β-lactams and amikacin (AMK). The results of the antimicrobial synergistic study showed no synergistic effect of low-dose meropenem (MEPM) and AMK combination therapy. The patient had acute renal failure, and it was difficult to increase the dose of MEPM and AMK, respectively. Thus, we initiated TAZ/CTLZ 1.5 g/8 h instead of the AMK and MEPM combination therapy on the 43rd day of hospitalization. Low-dose TAZ/CTLZ was continued because of prolonged renal dysfunction and resulted in a transient clinical improvement. However, the dosage of TAZ/CTLZ could be increased as the renal function improved, but despite an increased TAZ/CTLZ dose, bacteremia persisted, and the blood cultures remained positive. Thus, TOB was added to TAZ/CTLZ at low doses for synergistic effect against Gram-negative bacteria. Blood cultures collected after initiation of combination therapy with TAZ/CTLZ and low-dose TOB were negative on two consecutive follow-up evaluations. Thereafter, although the patient had several episodes of fever and increased inflammatory response, blood cultures consistently tested negative, and all of the wounds healed. On the 93rd day, due to the good healing progress, the patient was transferred to another hospital.

Conclusions: TAZ/CTLZ and low-dose TOB combination therapy showed the potential for synergistic effects. Our present report suggests a novel synergistic treatment strategy for rare cases that are refractory to the treatment of infections, such as XDR-P. aeruginosa infection.

Abstract Image

Abstract Image

他唑巴坦/头孢唑烷和妥布霉素联合治疗严重烧伤后广泛耐药铜绿假单胞菌感染1例。
背景:据报道,他唑巴坦/头孢氧唑烷(TAZ/CTLZ)和大剂量氨基糖苷类药物联合治疗广泛耐药(XDR)-铜绿假单胞菌感染有效。然而,没有关于XDR-P疗效的报道。低剂量氨基糖苷和TAZ/CTLZ联合治疗铜绿脓杆菌感染。在此,我们描述了一例罕见的严重烧伤患者,由于广泛耐药- p持续菌血症。TAZ/CTLZ联合小剂量妥布霉素(TOB)治疗铜绿假单胞菌(aeruginosa)。病例介绍:一名31岁男性因严重烧伤(烧伤面积占体表总面积的52%,预后烧伤指数为79.5)住进重症监护室。患者入院后反复出现细菌感染,入院第37天采集血液培养,发现铜绿假单胞菌(P. aeruginosa)菌株对所有β-内酰胺类和阿米卡星(AMK)耐药。抗菌增效研究结果显示,低剂量美罗培南(MEPM)与AMK联合治疗无增效作用。患者有急性肾功能衰竭,分别增加MEPM和AMK剂量困难。因此,我们在住院第43天开始TAZ/CTLZ 1.5 g/8 h,而不是AMK和MEPM联合治疗。低剂量TAZ/CTLZ继续治疗,因为肾功能不全时间延长,导致短暂的临床改善。然而,随着肾功能的改善,TAZ/CTLZ的剂量可以增加,但尽管TAZ/CTLZ剂量增加,菌血症持续存在,血培养仍呈阳性。因此,将TOB添加到TAZ/CTLZ中,以获得对革兰氏阴性菌的协同作用。开始TAZ/CTLZ联合治疗和低剂量TOB后收集的血培养在连续两次随访评估中均为阴性。此后,尽管患者有几次发烧和炎症反应增加,但血液培养始终呈阴性,所有伤口都愈合了。第93天,由于康复情况良好,患者转到另一家医院。结论:TAZ/CTLZ与小剂量TOB联合治疗具有潜在的协同作用。我们目前的报告提出了一种新的协同治疗策略,用于治疗难治性感染的罕见病例,如XDR-P。绿脓杆菌感染。
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来源期刊
CiteScore
1.80
自引率
0.00%
发文量
29
审稿时长
8 weeks
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