Combination of aztreonam, ceftazidime-avibactam and amikacin in the treatment of VIM-1 Pseudomonas aeruginosa ST235 osteomyelitis

Int J Infect Dis. 2021 Jul:108:510-512. doi: 10.1016/j.ijid.2021.05.085. Epub 2021 Jun 4.

Abstract

We describe a challenging case of patient with metallo-beta-lactamase-producing Pseudomonas aeruginosa sternal osteomyelitis following aortic valve replacement with biological prosthesis. The strain exhibited a multidrug-resistance phenotype carrying the blaVIM-1 gene and belonged to the high-risk clone sequence type ST235. The patient was successfully treated with surgical debridement plus antibiotic therapy with ceftazidime/avibactam, aztreonam, and amikacin. Time-kill curves showed that this triple antibiotic combination at 1 × MIC was strongly synergic after 8 h, achieving 99.9% killing and maintaining this until 48 h.

Keywords: Aztreonam; Ceftazidime–avibactam; Osteomyelitis; Pseudomonas aeruginosa; ST235; VIM-1.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Amikacin / therapeutic use*
  • Anti-Bacterial Agents / therapeutic use*
  • Azabicyclo Compounds / therapeutic use*
  • Aztreonam / therapeutic use*
  • Ceftazidime / therapeutic use*
  • Debridement
  • Drug Combinations
  • Drug Resistance, Multiple, Bacterial / genetics
  • Drug Therapy, Combination
  • Female
  • Humans
  • Osteomyelitis / drug therapy*
  • Osteomyelitis / microbiology
  • Osteomyelitis / surgery
  • Pseudomonas Infections / drug therapy*
  • Pseudomonas Infections / surgery
  • Pseudomonas aeruginosa*

Substances

  • Anti-Bacterial Agents
  • Azabicyclo Compounds
  • Drug Combinations
  • avibactam, ceftazidime drug combination
  • Amikacin
  • Ceftazidime
  • Aztreonam