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

Alessandra Mularoni; Maria Lina Mezzatesta; Michele Pilato; Alice Annalisa Medaglia; Adriana Cervo; Dafne Bongiorno; Ausilia Aprile; Angelo Luca; Stefania Stefani; Paolo Grossi

doi:10.1016/j.ijid.2021.05.085

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.

Affiliations

¹ Department of Infectious Diseases and Infection Control, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy. Electronic address: [email protected].
² Department of Biomedical and Biotechnological Sciences, Section of Microbiology, University of Catania, Italy.
³ Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy.
⁴ Department of Infectious Diseases and Infection Control, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy; Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Infectious Diseases Unit, University of Palermo, Italy.
⁵ Department of Infectious Diseases and Infection Control, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy; Department of Infectious Diseases, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy.
⁶ Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies, IRCCS-ISMETT, Palermo, Italy.
⁷ Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese, Italy.

PMID: 34091004
DOI: 10.1016/j.ijid.2021.05.085

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 bla_VIM-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