PDF(Pubmed)
Abstract：
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.
摘要：
由于缺乏有效的治疗选择，由广泛耐药（XDR）-铜绿假单胞菌引起的危重病人感染具有挑战性。头孢吡肟/齐达巴坦,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）是一种基于β-内酰胺/β-内酰胺增强剂组合的新型作用机制，具有对广泛的革兰氏阴性病原体，包括XDR铜绿假单胞菌。我们提供了一例腹腔感染引起的败血症患者，该患者感染了XDR铜绿假单胞菌，并在同情下成功使用头孢吡肟/齐达巴坦治疗。这位50岁的女性患者既往有减肥手术史，最近进行了选择性腹部成形术和吸脂术，出现了继发性肺炎，并在长时间的多粘菌素治疗中失败。从患者中反复分离的生物体是产生XDR的新德里金属β-内酰胺酶的铜绿假单胞菌，对头孢他啶/阿维巴坦具有抗性，亚胺培南/雷巴坦和头孢托赞/他唑巴坦，仅对头孢吡肟/齐达巴坦敏感。由于多粘菌素未能救出病人，头孢吡肟/齐达巴坦在同情的基础上给药，导致病情稳定的患者出院。本案例突出了抗生素耐药性的普遍不稳定情况，以及需要新型抗生素来应对由XDR表型病原体引起的感染。
