Long-Term Compassionate Use of Cefiderocol To Treat Chronic Osteomyelitis Caused by Extensively Drug-Resistant Pseudomonas aeruginosa and Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae in a Pediatric Patient

Antimicrob Agents Chemother. 2020 Mar 24;64(4):e01872-19. doi: 10.1128/AAC.01872-19. Print 2020 Mar 24.

Abstract

We report a 15 year-old Nigerian adolescent male with chronic osteomyelitis caused by an extensively drug-resistant (XDR) Pseudomonas aeruginosa strain of sequence type 773 (ST773) carrying blaNDM-1 and an extended spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae strain. The patient developed neurological side effects in the form of circumoral paresthesia with polymyxin B and asymptomatic elevation of transaminases with aztreonam (used in combination with ceftazidime-avibactam). Cefiderocol treatment for 14 weeks plus bone implantation resulted in apparent cure and avoided amputation.

Keywords: ESBL-producing Klebsiella pneumoniae; XDR Pseudomonas aeruginosa; cefiderocol; chronic osteomyelitis; pediatric.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / therapeutic use*
  • Cefiderocol
  • Cephalosporins / therapeutic use*
  • Compassionate Use Trials / methods*
  • Drug Resistance, Multiple, Bacterial / genetics
  • Humans
  • Klebsiella pneumoniae / drug effects*
  • Male
  • Microbial Sensitivity Tests
  • Nigeria
  • Osteomyelitis / drug therapy
  • Osteomyelitis / microbiology
  • Pseudomonas aeruginosa / drug effects*
  • Surgical Wound Infection / drug therapy*
  • Surgical Wound Infection / microbiology
  • beta-Lactam Resistance / genetics
  • beta-Lactamases / genetics

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • beta-Lactamases
  • beta-lactamase NDM-1