Investigational antibiotic cefepime/zidebactam as a therapeutic option for the treatment of an unyielding empyema in a paediatric patient caused by extensively drug-resistant Pseudomonas aeruginosa: a case report.

Objective: Treatment option for the infections caused by MBL-producing P. aeruginosa is severely limited. Cefepime/zidebactam (WCK 5222) is a novel β-lactam/ β-lactam-enhancer combination, currently in global Phase 3 clinical development. It is reported to show a broad-spectrum in vitro activity and translational efficacy in non-clinical PK/PD models against carbapenem-resistant Gram-negative bacteria including MBL-producing P. aeruginosa. We present a case of a 13-year-old girl, suffering from tuberculosis with a refractory lung empyema caused by NDM-producing, XDR P. aeruginosa who did not respond to several rounds of colistin or aztreonam plus ceftazidime/avibactam therapies albeit effective source control, over 4 months period.

Methods: The infecting organism was found to be susceptible to cefepime/zidebactam. After obtaining informed consent and necessary approvals, the patient was treated under compassionate ground.

Results: The patient was treated with adult dose regimen of cefepime/zidebactam (due to higher body weight) for 21 days that led to clinical and microbiological cure.

Conclusion: This case highlights both severity of the antimicrobial resistance and hope offered by an under-trial novel antibiotic.