De León-Borrás Rafael, Álvarez-Cardona Julio, Vidal Jorge A, Guiot Humberto M
Division of Infectious Diseases, Department of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR; Department of Internal Medicine, VA Caribbean Healthcare System, San Juan, PR.
Department of Radiology, University of Puerto Rico Medical Sciences Campus, San Juan, PR; Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
P R Health Sci J. 2018 Jun;37(2):128-131.
A 36-year-old man was admitted to the intensive care unit due to diabetic ketoacidosis and pneumonia requiring mechanical ventilation. Three weeks after admission, he developed a refractory bacteremia with Klebsiella pneumoniae carbapenemase-producing bacteria (KPC). He remained febrile and with bacteremia for six weeks despite therapy with polymyxin B, carbapenems, and amikacin. Imaging studies looking for deep-seated infection revealed vertebral L1-L2 diskitis and osteomyelitis with pre-vertebral abscess and bilateral psoas pyomyositis that were not amenable for drainage. In view of the refractory infection and the activity against KPC described in the literature, we decided to switch the patient to ceftazidime/avibactam. After six weeks of therapy, there was complete resolution of the infectious processes. We present an instance of clinical success with ceftazidime/avibactam for the treatment of refractory KPC bacteremia, vertebral diskitis and osteomyelitis with pre-vertebral abscess and bilateral psoas pyomyositis. This experience serves as reference to support treatment with ceftazidime/avibactam in similar complicated cases.
一名36岁男性因糖尿病酮症酸中毒和需要机械通气的肺炎入住重症监护病房。入院三周后，他出现了由产碳青霉烯酶肺炎克雷伯菌（KPC）引起的难治性菌血症。尽管接受了多粘菌素B、碳青霉烯类药物和阿米卡星治疗，但他持续发热并菌血症六周。寻找深部感染的影像学检查显示L1-L2椎体椎间盘炎和骨髓炎，伴有椎前脓肿和双侧腰大肌脓性肌炎，无法进行引流。鉴于难治性感染以及文献中描述的对KPC的活性，我们决定将患者的治疗改为头孢他啶/阿维巴坦。经过六周的治疗，感染过程完全消退。我们展示了头孢他啶/阿维巴坦成功治疗难治性KPC菌血症、椎体椎间盘炎和骨髓炎伴椎前脓肿和双侧腰大肌脓性肌炎的临床实例。这一经验可为类似复杂病例中使用头孢他啶/阿维巴坦治疗提供参考。
