The dilemma of antibiotic susceptibility and clinical decision-making in a multi-drug-resistant Pseudomonas aeruginosa bloodstream infection

Frontiers in Pharmacology

Pharmacology

Gang Wu¹  Haijun Yao¹  Long Chen¹  Qiang Yuan¹  Jin Hu¹  Yu Wang²  Xiaofen Liu²  Jing Zhang³  Xingyi Qu³  Jingqian Su⁴  Nanyang Li⁵ 

[1]Department of Neurosurgery and Neurocritical Care, Huashan Hospital, Fudan University, Shanghai, China

[2]Fudan University and Key Laboratory of Clinical Pharmacology of Antibiotics and National Health Commission and National Clinical Research Center for Aging and Medicine, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China

[3]Fudan University and Key Laboratory of Clinical Pharmacology of Antibiotics and National Health Commission and National Clinical Research Center for Aging and Medicine, Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China

[4]Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China

[5]Fujian Key Laboratory of Innate Immune Biology, Biomedical Research Center of South China, College of Life Science, Fujian Normal University, Fuzhou, China

[6]Phase I Unit, Huashan Hospital, Fudan University, Shanghai, China

关键词: therapeutic drug monitoring;    pharmacokinetics/pharmacodynamics;    multidisciplinary treatment;    Pseudomonas aeruginosa;    bloodstream infection;   

DOI  :  10.3389/fphar.2023.1183332

 received in 2023-03-13, accepted in 2023-05-15,  发布年份 2023

来源: Frontiers

【 摘 要 】

Objective: How to choose the appropriate antibiotics and dosage has always been a difficult issue during the treatment of multi-drug-resistant bacterial infections. Our study aims to resolve this difficulty by introducing our multi-disciplinary treatment (MDT) clinical decision-making scheme based on rigorous interpretation of antibiotic susceptibility tests and precise therapeutic drug monitoring (TDM)-guided dosage adjustment.Method: The treatment course of an elderly patient who developed a multi-drug-resistant Pseudomonas aeruginosa (MDRPA) bloodstream infection from a brain abscess was presented.Results: In the treatment process, ceftazidime–avibactam (CAZ–AVI) was used empirically for treating the infection and clinical symptoms improved. However, the follow-up bacterial susceptibility test showed that the bacteria were resistant to CAZ–AVI. Considering the low fault tolerance of clinical therapy, the treatment was switched to a 1 mg/kg maintenance dose of susceptible polymyxin B, and TDM showed that the AUC24h, ss of 65.5 mgh/L had been achieved. However, clinical symptoms were not improved after 6 days of treatment. Facing the complicated situation, the cooperation of physicians, clinical pharmacologists, and microbiologists was applied, and the treatment finally succeeded with the pathogen eradicated when polymyxin B dose was increased to 1.4 mg/kg, with the AUC24h, ss of 98.6 mgh/L.Conclusion: MDT collaboration on the premise of scientific and standardized drug management is helpful for the recovery process in patients. The empirical judgment of doctors, the medication recommendations from experts in the field of TDM and pharmacokinetics/pharmacodynamics, and the drug susceptibility results provided by the clinical microbiology laboratory all provide the direction of treatment.

【 授权许可】

Unknown   
Copyright © 2023 Chen, Qu, Su, Yao, Yuan, Wang, Li, Wu, Liu, Hu and Zhang.