Unidad de Gestión Clínica Farmacia Hospitalaria, Hospital Juan Ramon Jimenez, Huelva, Spain
Unidad de Gestión Clínica Farmacia Hospitalaria, Hospital Juan Ramon Jimenez, Huelva, Spain.
Eur J Hosp Pharm. 2022 Mar;29(2):113-115. doi: 10.1136/ejhpharm-2021-002772. Epub 2021 Oct 29.
The case of a female who had an accident that caused an open fracture is reported. During hospitalisation, Verona integron-encoded metallo-β-lactamase (VIM)-producing was isolated. Antimicrobial susceptibility testing revealed resistance to β-lactam antibiotics, quinolones, trimethoprim/sulfamethoxazole, and susceptibility to tigecycline, colistin, fosfomycin and aminoglycosides. Synergistic activity of ceftazidime-avibactam and aztreonam was proved in vitro and a combined therapy with tigecycline was started. Combination with aminoglycosides was ruled out as it was not described in the literature and also in order to avoid side effects. Colistin was rejected because of its nephrotoxicity profile. The antibiotic treatment was assessed by a multidisciplinary team with a pharmacist who closely monitored adverse effects and interactions with other drugs. The total duration of this combination was 25 days, without any adverse events reported. Fourteen weeks after the accident the patient was discharged. After 2 months of follow-up neither relapses nor reinfections have been reported.
现报告一例女性意外导致开放性骨折的病例。在住院期间，分离出了产 Verona 整合子编码金属β-内酰胺酶（VIM）的。药敏试验显示对β-内酰胺类抗生素、喹诺酮类、甲氧苄啶/磺胺甲恶唑耐药，对替加环素、黏菌素、磷霉素和氨基糖苷类敏感。体外证明头孢他啶-阿维巴坦和氨曲南具有协同作用，并开始联合使用替加环素治疗。由于在文献中未描述且为避免副作用，排除了与氨基糖苷类药物联合使用。由于其肾毒性，拒绝使用黏菌素。抗生素治疗由多学科团队进行评估，药剂师密切监测不良反应和与其他药物的相互作用。这种联合治疗总共持续了 25 天，没有报告任何不良反应。事故发生后 14 周，患者出院。随访 2 个月后，未报告复发或再感染。
