Abstract
Treatment of infections caused by multidrug-resistant Pseudomonas species is difficult because few antibiotics active against such organisms are available. Arbekacin, a relatively new aminoglycoside, is effective against Pseudomonas spp. in vitro. However, no clinical report on arbekacin treatment of a human infection with a multidrug-resistant Pseudomonas has appeared to date. We encountered a case of pneumonia caused by a Pseudomonas strain producing a metallo-beta-lactamase; the patient was successfully treated with arbekacin. A 69-year-old male presented to our hospital experiencing cardiac arrest after rescue from water. Spontaneous circulation had earlier resumed after brief application of cardiopulmonary resuscitation. The patient was subjected to induced hypothermia. He experienced severe acute respiratory distress syndrome. The patient regained consciousness on day 8 post-admission. Episodes of ventilator-associated pneumonia were recorded on days 5 and 12. The causative organism was a strain of Pseudomonas putida that produced a metallo-beta-lactamase. Combination therapy with arbekacin and levofloxacin successfully resolved the pneumonia. The patient was transferred to another hospital on day 37 to undergo further rehabilitation. Strains of P. putida producing metallo-beta-lactamases have become more widespread in recent years. Colistin is traditionally the drug of last resort to treat infections with multidrug-resistant Pseudomonas. However, colistin use is associated with a very high frequency of adverse effects, and the costs of such therapy are not covered by the Japanese health insurance system. Our results indicate that arbekacin is an efficient alternative to multidrug-resistant Pseudomonas.
Highlights
Infections caused by Pseudomonas putida strains that produce metallo-beta-lactamases (MBLs) are difficult to treat because effective antibiotics are lacking
To the best of our knowledge, no clinical report on ABK treatment of pneumonia caused by MBL-producing P. putida has yet appeared
Infections caused by MBL-producing P. putida are difficult to treat, especially in Japan, where health insurance covers the use of relatively few antibiotics
Summary
Infections caused by Pseudomonas putida strains that produce metallo-beta-lactamases (MBLs) are difficult to treat because effective antibiotics are lacking. To the best of our knowledge, no clinical report on ABK treatment of pneumonia caused by MBL-producing P. putida has yet appeared. The patient was diagnosed as post cardiac arrest due to severe hypoxia. He was subjected to induced hypothermia (34°C for 24 h). The patient experienced general edema and impairment of renal function, and the blood concentration of vancomycin hydrochloride was much greater than the predicted value. We, replaced this drug with linezolid on day 7. The blood concentration of vancomycin exceeded the predicted value when the drug was used in the earlier treatment. The patient was transferred to another hospital on day 37 for further rehabilitation
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