Cure of Limb-Threatening XDR Pseudomonas aeruginosa Infection: Combining Genome Sequencing, Therapeutic Drug Level Monitoring, and Surgical Debridement

Shanti Narayanasamy; Roger L Nation; Andrew A Mahony; M Lindsay Grayson; Jason C Kwong; Norelle L Sherry; Sharmila Khumra; Andrew G Ellis; Albert G Frauman; Natasha E Holmes

doi:10.1093/ofid/ofaa572

Cure of Limb-Threatening XDR Pseudomonas aeruginosa Infection: Combining Genome Sequencing, Therapeutic Drug Level Monitoring, and Surgical Debridement

Open Forum Infect Dis. 2020 Nov 26;8(1):ofaa572. doi: 10.1093/ofid/ofaa572. eCollection 2021 Jan.

Authors

Shanti Narayanasamy¹, Roger L Nation², Andrew A Mahony¹, M Lindsay Grayson^{1

3}, Jason C Kwong^{1

4}, Norelle L Sherry^{1

4}, Sharmila Khumra⁵, Andrew G Ellis^{3

6}, Albert G Frauman^{3

6}, Natasha E Holmes^{1

3}

Affiliations

¹ Department of Infectious Diseases, Austin Health, Melbourne, Australia.
² Drug Delivery, Disposition and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia.
³ Department of Medicine, University of Melbourne, Melbourne, Australia.
⁴ Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne at the Doherty Institute for Infection & Immunity, Melbourne, Australia.
⁵ Department of Pharmacy, Austin Health, Melbourne, Australia.
⁶ Department of Clinical Pharmacology, Austin Health, Melbourne, Australia.

Abstract

We describe a case of limb-threatening osteomyelitis and metalware infection with carbapenemase-producing extensively drug-resistant Pseudomonas aeruginosa successfully cured with aggressive surgical debridement and combined intravenous fosfomycin and colistin. Real-time therapeutic drug monitoring was used to maximize probability of efficacy and minimize potential for toxicity.

Keywords: XDR gram-negative; colistin; fosfomycin; osteomyelitis; therapeutic drug monitoring.

Publication types

Case Reports