Continuous infusion of ceftolozane-tazobactam resulted in high cerebrospinal fluid concentrations of ceftolozane in a pa
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CASE REPORT
Continuous infusion of ceftolozane‑tazobactam resulted in high cerebrospinal fluid concentrations of ceftolozane in a patient with multidrug‑resistant Pseudomonas aeruginosa meningitis S. Alexander Winans1 · Richelle L. Guerrero‑Wooley2 · Susie H. Park3 · Garret Hino Jr.3 · Steven C. Forland1,2,3 Received: 22 July 2020 / Accepted: 19 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Multidrug-resistant Pseudomonas aeruginosa has limited treatment options. Treatment of healthcare-associated meningitis requires agents active against the organism in vitro and able to penetrate the cerebrospinal fluid adequately. Ceftolozanetazobactam has been recently approved to treat various Gram-negative organisms, including Pseudomonas aeruginosa; however, ceftolozane’s penetration into human cerebrospinal fluid is unknown. Here, we present a case of a patient with multidrug-resistant Pseudomonas aeruginosa meningitis treated with a continuous infusion of ceftolozane-tazobactam. Samples of both serum and cerebrospinal fluid were analyzed for ceftolozane concentration on continuous infusion. Cerebrospinal fluid concentrations of ceftolozane were 83% of that in serum. Treatment with ceftolozane-tazobactam, along with combinations of other antibiotics, resulted in clearance of organism from the patient’s cerebrospinal fluid and marked decrease in inflammatory cells. Studies are warranted to determine the efficacy of ceftolozane-tazobactam for patients with healthcare-associated meningitis. Keywords Ceftolozane-tazobactam · Cerebrospinal fluid · Pseudomonas aeruginosa · Meningitis
Introduction Multidrug-resistant (MDR) Pseudomonas aeruginosa has been deemed a serious threat in the United States by the Centers for Disease Control and Prevention (CDC), accounting for 6700 infections and 440 deaths annually [1]. A recent survey by the US National Healthcare Safety Network (NHSN) reported approximately 15–20% of hospitalacquired infections caused by P. aeruginosa were considered multidrug-resistant [2, 3]. In order to combat the emergence of MDR P. aeruginosa, the US Food and Drug Administration (FDA) approved the cephalosporin/beta-lactamase inhibitor combination ceftolozane-tazobactam (C-T) in * S. Alexander Winans [email protected] 1
Department of Pharmacy, Loma Linda University Medical Center, 11223 Campus Street, Loma Linda, CA 92354, USA
2
Loma Linda University School of Medicine, Loma Linda, CA, USA
3
Department of Pharmacy Practice, Loma Linda University School of Pharmacy, Loma Linda, CA, USA
2014. Currently, the combination drug is approved in the US for complicated intra-abdominal infections, complicated urinary tract infections, hospital-acquired bacterial pneumonia, and ventilator-associated bacterial pneumonia [4]. Nosocomial meningitis patients are at risk for infections caused by P. aeruginosa. In one recent meta-analysis of ventriculostomy infections, up to 31% of positive cerebrospinal fluid (CSF) cultures grew Pseudomonas species [5]. Limited drug option
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