Abstract
Abstract Background Infective endocarditis (IE) due to multi-drug (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa is rare. MDR P. aeruginosa infections are increasingly reported worldwide, and the choice of effective antimicrobials is limited. Ceftolozane-tazobactam is a new antimicrobial combination with activity against many resistant strains of P. aeruginosa, but there are limited data on its use in complex infections. Methods We present the first reported cases of XDR P. aeruginosa IE and MDR P. aeruginosa intravascular catheter-related bloodstream infection [CRBSI] with possible IE to be treated with ceftolozane-tazobactam in combination with other agents. Results Patient 1 completed seven weeks treatment with ceftolozane-tazobactam and fosfomycin, in combination with valve replacement, for XDR P. aeruginosa IE and is 2 year post-treatment without signs of relapse. Patient 2 completed 4 weeks treatment with ceftolozane-tazobactam and fosfomycin for MDR P. aeruginosa intravascular CRBSI with possible IE and went 8 months before MDR P. aeruginosa was cultured again from a line culture and tip. Conclusions These cases highlight the difficulties of managing IE caused by MDR and XDR P. aeruginosa infections and indicate that ceftolozane-tazobactam may be effective when there are no alternative beta-lactams.
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