Ceftazidime/avibactam and ceftolozane/tazobactam for the treatment of extensively drug-resistant Pseudomonas aeruginosa
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CASE REPORT
Ceftazidime/avibactam and ceftolozane/tazobactam for the treatment of extensively drug‑resistant Pseudomonas aeruginosa post‑neurosurgical infections: three cases and a review of the literature Marianna Meschiari1 · Iacopo Franconi2 · Erica Bacca2 · Vincenzo Bianco3 · Gabriella Orlando1 · Gianluca Cuomo1 · Andrea Bedini1 · Cristina Mussini2 Received: 24 July 2020 / Accepted: 8 October 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Post-neurosurgical infection caused by extensively drug resistant Pseudomonas aeruginosa (XDR-PA) are becoming a matter of great concern due to limited therapeutic options. Although not approved for these indications, the new BetaLactam-BetaLactamase Inhibitor combinations (BLBLIs) could represent a valid salvage treatment. We describe one nosocomial meningitis and two cervical osteomyelitis due to an XDR-PA who were treated with ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T) and review the literature. Methods The first and the third patients developed an osteomyelitis following cervical stabilization surgery due to an XDRPA. Although the first patient started treatment with a high dose of C/T, resistance to C/T occurred, so therapy was switched to CZA plus aztreonam. The third patient switched to aztreonam plus CZA due to development of acute kidney injury during therapy with colistin. The second patient had an XDR-PA meningitis following the insertion of an external ventricular catheter and he was treated with C/T plus meropenem and amikacin. Results All three cases reported were successfully conservatively treated thanks to the use of the new BLBLIs with different combinations. Only few experiences demonstrated an equally favorable outcome: one patient treated with C/T plus fosfomycin for otogenic meningitis caused by an XDR-PA and another case of XDR-PA post-surgical meningitis with CZA in combination with colistin. Finally, the combination of CZA plus aztreonam has proven to be effective on XDR-PA only in limited mostly in vitro studies. Conclusion These recently developed antibiotics, C/T and CZA are promising and complementary therapy options against post-neurosurgical hard-to-treat P. aeruginosa infections. Further prospective real-life studies are required to validate these findings in this special setting. Keywords Extensively drug resistant Pseudomonas aeruginosa · Meningitis · Cervical osteomyelitis · Ceftazidime/ avibactam · Ceftolozane/tazobactam * Marianna Meschiari [email protected]; [email protected] * Cristina Mussini [email protected] 1
Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy
2
Department of Infectious Diseases, University of Modena and Reggio Emilia, Modena, Italy
3
Infectious Diseases Clinic, Università degli Studi Federico II, Naples, Italy
Introduction Extensively drug resistant Pseudomonas aeruginosa (XDRPA) is an emerging pathogen associated with h
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