Institute of Critical Care medicine, Medanta, Lucknow, India.
Department of Pulmonary Medicine, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, India.
Ann Clin Microbiol Antimicrob. 2023 Jul 5;22(1):55. doi: 10.1186/s12941-023-00606-x.
Infections in critically-ill patients caused by extensively-drug-resistant (XDR)-Pseudomonas aeruginosa are challenging to manage due to paucity of effective treatment options. Cefepime/zidebactam, which is currently in global Phase 3 clinical development (Clinical Trials Identifier: NCT04979806, registered on July 28, 2021) is a novel mechanism of action based β-lactam/ β-lactam-enhancer combination with a promising activity against a broad-range of Gram-negative pathogens including XDR P. aeruginosa. We present a case report of an intra-abdominal infection-induced sepsis patient infected with XDR P. aeruginosa and successfully treated with cefepime/zidebactam under compassionate use. The 50 year old female patient with past-history of bariatric surgery and recent elective abdominoplasty and liposuction developed secondary pneumonia and failed a prolonged course of polymyxins. The organism repeatedly isolated from the patient was a New-Delhi metallo β-lactamase-producing XDR P. aeruginosa resistant to ceftazidime/avibactam, imipenem/relebactam and ceftolozane/tazobactam, susceptible only to cefepime/zidebactam. As polymyxins failed to rescue the patient, cefepime/zidebactam was administered under compassionate grounds leading to discharge of patient in stable condition. The present case highlights the prevailing precarious scenario of antimicrobial resistance and the need for novel antibiotics to tackle infections caused by XDR phenotype pathogens.
由于缺乏有效的治疗选择,重症患者中由广泛耐药(XDR)铜绿假单胞菌引起的感染难以治疗。头孢吡肟/齐他培南,目前正在进行全球 3 期临床开发(临床试验标识符:NCT04979806,于 2021 年 7 月 28 日注册),是一种新的作用机制的β-内酰胺/β-内酰胺增强剂组合,对包括 XDR 铜绿假单胞菌在内的广泛革兰氏阴性病原体具有有前途的活性。我们报告了一例腹腔感染诱导性败血症患者的病例报告,该患者感染了 XDR 铜绿假单胞菌,在同情用药下成功接受头孢吡肟/齐他培南治疗。这名 50 岁女性患者有减肥手术史,最近接受了腹部整形术和脂肪抽吸术,继发肺炎,并经历了延长的多粘菌素疗程失败。从患者中反复分离出的病原体是一种新德里金属β-内酰胺酶产生的 XDR 铜绿假单胞菌,对头孢他啶/阿维巴坦、亚胺培南/雷巴他定和头孢洛扎/他唑巴坦耐药,仅对头孢吡肟/齐他培南敏感。由于多粘菌素未能挽救患者,根据同情用药原则给予头孢吡肟/齐他培南治疗,使患者病情稳定出院。本病例突出了抗菌药物耐药性的普遍危险局面,需要新型抗生素来应对 XDR 表型病原体引起的感染。
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