Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy.
Cardiothoracic Department, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy.
Infection. 2018 Apr;46(2):263-265. doi: 10.1007/s15010-017-1086-0. Epub 2017 Oct 31.
Ceftolozane/tazobactam (C/T) is a novel antibiotic with enhanced microbiological activity against multidrug-resistant (MDR) gram-negative bacteria, including MDR Pseudomonas aeruginosa.
Five months after left ventricular assist device (LVAD) implantation, a 49-year old man developed fever and blood culture was positive for MDR P. aeruginosa, susceptible only to aminoglycosides, ciprofloxacin and colistin. A diagnosis of LVAD-related infection was made based on persistent bacteremia associated with moderate 18 F-fluorodeoxyglucose positron emission tomography/CT uptake in the left ventricular apex. Disk diffusion testing for C/T was performed (MIC 2 μg/mL) and intravenous antibiotic therapy with C/T and amikacin was started, with clinical and microbiological response. Initial conservative management with 6 weeks of systemic antibiotic therapy was attempted, but the patient relapsed one month after antibiotic discontinuation. Priority for transplantation was given and after 4 weeks of antibiotic therapy (C/T + amikacin), LVAD removal and heart transplant were performed, with no infection relapse.
We reported the first off-label use of C/T in the management of MDR P. aeruginosa LVAD infection as a bridge to heart transplant. C/T has shown potent anti-pseudomonal activity and good safety profile making this drug as a good candidate for suppressive strategy in intravascular device-associated bloodstream infections caused by MDR P. aeruginosa.
头孢他啶/他唑巴坦（C/T）是一种新型抗生素，对包括多重耐药铜绿假单胞菌（MDR P. aeruginosa）在内的多种耐药革兰氏阴性菌具有增强的微生物学活性。
一名 49 岁男性在植入左心室辅助装置（LVAD）五个月后出现发热，血培养为 MDR 铜绿假单胞菌阳性，仅对氨基糖苷类、环丙沙星和黏菌素敏感。根据左心室心尖部持续菌血症伴中等程度 18 F-氟脱氧葡萄糖正电子发射断层扫描/CT 摄取，诊断为与 LVAD 相关的感染。进行了头孢他啶/他唑巴坦的药敏试验（MIC2μg/ml），并开始静脉注射头孢他啶/阿米卡星联合抗生素治疗，取得了临床和微生物学的疗效。最初尝试了 6 周的系统抗生素治疗，但在停药一个月后患者复发。优先进行移植，在接受 4 周抗生素治疗（头孢他啶/阿米卡星）后，进行了 LVAD 移除和心脏移植，没有感染复发。
我们报告了首例将头孢他啶/他唑巴坦用于治疗 MDR 铜绿假单胞菌 LVAD 感染的标签外应用，作为心脏移植的桥梁。头孢他啶/他唑巴坦具有强大的抗假单胞菌活性和良好的安全性，使其成为治疗 MDR 铜绿假单胞菌引起的血管内装置相关血流感染的抑制策略的良好候选药物。
