Hasan Md Jahidul, Nizhu Lutfun Nahar, Rabbani Raihan
Department of Pharmacy, Square Hospitals Ltd., 18/F Bir Uttam Qazi Nuruzzaman Sarak, West Panthapath, Dhaka 1205, Bangladesh.
Internal Medicine and ICU, Square Hospitals Ltd., Dhaka, Bangladesh.
IDCases. 2019 Jul 15;18:e00600. doi: 10.1016/j.idcr.2019.e00600. eCollection 2019.
is a species of gram-negative, rod-shaped, aerobic bacteria commonly found in the environment. -associated nosocomial infections are common in hospitalized patients, but serious life threatening infections are rare. Here, we report a rare case of BSI with resistant to all available antibiotics; successfully treated with double-dose of tigecycline.
A 60-year-old female presented with bloodstream infection, where the organism was completely resistant to all commercially available antibiotics including polymyxins and tigecycline. The physical condition of the patient was deteriorating and there were no active antibiotics available to prescribe based on sensitivities. Despite the organism's resistance to tigecycline, double-dose of tigecycline therapy (100 mg twice daily, intravenously after a 200 mg single intravenous loading dose) was prescribed intentionally for the treatment of this infection. The organism was completely eradicated from the bloodstream of that patient within the 5 days of therapy-initiation.
Double-dose of tigecycline maintains a higher serum drug concentration rather than the standard dose, and in this case, double-dose of tigecycline completely cleared the pandrug-resistant from the blood where initially, that organism was resistant to tigecycline. Previously, were found resistant to fluoroquinolones, but here it was found very rarely resistant to even reserve antibiotics, polymyxins, carbapenems and tigecycline.
Pandrug-resistant associated bloodstream infection is a very uncommon case and double-dose of tigecycline may be an effective option to treat it.
是一种革兰氏阴性、杆状需氧菌，常见于环境中。与相关的医院感染在住院患者中很常见，但严重危及生命的感染很少见。在此，我们报告一例罕见的对所有可用抗生素均耐药的血流感染病例，该病例成功接受了双倍剂量替加环素治疗。
一名60岁女性出现血流感染，感染的病原体对所有市售抗生素包括多粘菌素和替加环素均完全耐药。患者身体状况不断恶化，根据药敏试验结果没有可用的有效抗生素。尽管该病原体对替加环素耐药，但仍有意采用双倍剂量替加环素治疗（单次静脉负荷剂量200mg后，每日两次，每次100mg静脉注射）。在开始治疗的5天内，该病原体从患者血液中被完全清除。
双倍剂量替加环素能维持比标准剂量更高的血清药物浓度，在本病例中，双倍剂量替加环素完全清除了血液中的泛耐药菌，而该菌最初对替加环素耐药。此前已发现对氟喹诺酮类耐药，但在此病例中发现甚至对储备抗生素多粘菌素、碳青霉烯类和替加环素也很少耐药。
泛耐药菌相关的血流感染是非常罕见的病例，双倍剂量替加环素可能是治疗此类感染的有效选择。
