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[PMID]: | 28767588 |
[Au] Autor: | Gugliandolo A; Caio C; Mezzatesta ML; Rifici C; Bramanti P; Stefani S; Mazzon E |
[Ad] Endereço: | aIRCCS Centro Neurolesi "Bonino-Pulejo", Via Provinciale Palermo, Messina bSection of Microbiology, Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy. |
[Ti] Título: | Successful ceftazidime-avibactam treatment of MDR-KPC-positive Klebsiella pneumoniae infection in a patient with traumatic brain injury: A case report. |
[So] Source: | Medicine (Baltimore);96(31):e7664, 2017 Aug. | [Is] ISSN: | 1536-5964 |
[Cp] País de publicação: | United States |
[La] Idioma: | eng |
[Ab] Resumo: | RATIONALE: Carbapenem-resistant Enterobacteriaceae infections are a serious health care problem, because of the high mortality. Carbapenem resistance is mainly caused by carbapenemases production, including Klebsiella pneumoniae carbapenemase (KPC). Ceftazidime-avibactam is a new cephalosporin/ß-lactamase inhibitor combination for the treatment of complicated urinary, intra-abdominal infections, and nosocomial pneumonia caused by gram negative, or other serious gram-negative infections. PATIENT CONCERNS: We showed the case of a 27-year-old patient, hospitalized for traumatic brain injury and chest trauma, with KPC-producing Klebsiella pneumoniae infection. DIAGNOSES: Blood and bronchial aspirate culture analysis detected an infection caused by MDR Klebsiella pneumoniae, resistant to meropenem, ertapenem, piperacillin/tazobactam, amoxicillin/clavulanic acid, aztreonam, ceftazidime, cefotaxime, cefepime, amikacin, ciprofloxacin, trimethoprim/sulfamethoxazole, colistin while it showed an intermediate sensitivity to gentamicin and was sensitive to ceftazidime-avibactam. Molecular analyses revealed that the isolate belonged to the epidemic clone sequence type 258 (ST258) carrying blaKPC-3, blaTEM-1, and blaSHV-11genes. INTERVENTIONS: After various combined antibiotic therapies without improvements, he was treated with ceftazidime-avibactam, on a compassionate-use basis. OUTCOMES: With ceftazidime-avibactam monotherapy clinical and microbiological clearance was obtained. A week after the end of the therapy microbiological analysis was repeated and a positive rectal swab for KPC-Klebsiella pneumoniae was found, becoming negative after 1 month. Moreover, the patient did not show any relapses for up to 18 weeks. LESSONS: This case indicates that ceftazidime-avibactam monotherapy could be efficacious against KPC positive Klebsiella pneumoniae infections. |
[Mh] Termos MeSH primário: |
Compostos Azabicíclicos/uso terapêutico Lesões Encefálicas Traumáticas/complicações Ceftazidima/uso terapêutico Infecções por Klebsiella/tratamento farmacológico Klebsiella pneumoniae Inibidores de beta-Lactamases/uso terapêutico
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[Mh] Termos MeSH secundário: |
Adulto Lesões Encefálicas Traumáticas/microbiologia Ensaios de Uso Compassivo Estado Terminal Farmacorresistência Bacteriana Múltipla Seres Humanos Infecções por Klebsiella/complicações Klebsiella pneumoniae/efeitos dos fármacos Klebsiella pneumoniae/genética Masculino
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[Pt] Tipo de publicação: | CASE REPORTS; JOURNAL ARTICLE |
[Nm] Nome de substância:
| 0 (Azabicyclo Compounds); 0 (avibactam, ceftazidime drug combination); 0 (beta-Lactamase Inhibitors); 9M416Z9QNR (Ceftazidime) |
[Em] Mês de entrada: | 1708 |
[Cu] Atualização por classe: | 171013 |
[Lr] Data última revisão:
| 171013 |
[Sb] Subgrupo de revista: | AIM; IM |
[Da] Data de entrada para processamento: | 170803 |
[St] Status: | MEDLINE |
[do] DOI: | 10.1097/MD.0000000000007664 |
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