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Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients

The effectiveness of ceftolozane/tazobactam for the treatment of infections in neutropenic patients caused by hypervirulent multidrug-resistant (MDR) Pseudomonas aeruginosa has not been previously reported. We identified seven cases of MDR P. aeruginosa infection in neutropenic patients over a four-...

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Autores principales: Coppola, Paolo E., Gaibani, Paolo, Sartor, Chiara, Ambretti, Simone, Lewis, Russell E., Sassi, Claudia, Pignatti, Marco, Paolini, Stefania, Curti, Antonio, Castagnetti, Fausto, Ursi, Margherita, Cavo, Michele, Stanzani, Marta
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767535/
https://www.ncbi.nlm.nih.gov/pubmed/33371496
http://dx.doi.org/10.3390/microorganisms8122055
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author Coppola, Paolo E.
Gaibani, Paolo
Sartor, Chiara
Ambretti, Simone
Lewis, Russell E.
Sassi, Claudia
Pignatti, Marco
Paolini, Stefania
Curti, Antonio
Castagnetti, Fausto
Ursi, Margherita
Cavo, Michele
Stanzani, Marta
author_facet Coppola, Paolo E.
Gaibani, Paolo
Sartor, Chiara
Ambretti, Simone
Lewis, Russell E.
Sassi, Claudia
Pignatti, Marco
Paolini, Stefania
Curti, Antonio
Castagnetti, Fausto
Ursi, Margherita
Cavo, Michele
Stanzani, Marta
author_sort Coppola, Paolo E.
collection PubMed
description The effectiveness of ceftolozane/tazobactam for the treatment of infections in neutropenic patients caused by hypervirulent multidrug-resistant (MDR) Pseudomonas aeruginosa has not been previously reported. We identified seven cases of MDR P. aeruginosa infection in neutropenic patients over a four-month period within the same hematology ward. Four cases were associated with rapid progression despite piperacillin-tazobactam or meropenem therapy, and three patients developed sepsis or extensive skin/soft tissue necrosis. In three of the four cases, patients were empirically switched from meropenem to ceftolozane/avibactam before carbapenem susceptibility test results were available, and all four patients underwent extensive surgical debridement or amputation of affected tissues and survived. Further investigation revealed a common bathroom source of MDR P. aeruginosa clonal subtypes ST175 and ST235 that harbored genes for type III secretion system expression and elaboration of ExoU or ExoS exotoxin. We conclude that ceftolozane/tazobactam plus early source control was critical for control of rapidly progressing skin and soft infection in these neutropenic patients caused by highly virulent ST175 and ST235 clones of MDR P. aeruginosa.
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spelling pubmed-77675352020-12-28 Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients Coppola, Paolo E. Gaibani, Paolo Sartor, Chiara Ambretti, Simone Lewis, Russell E. Sassi, Claudia Pignatti, Marco Paolini, Stefania Curti, Antonio Castagnetti, Fausto Ursi, Margherita Cavo, Michele Stanzani, Marta Microorganisms Case Report The effectiveness of ceftolozane/tazobactam for the treatment of infections in neutropenic patients caused by hypervirulent multidrug-resistant (MDR) Pseudomonas aeruginosa has not been previously reported. We identified seven cases of MDR P. aeruginosa infection in neutropenic patients over a four-month period within the same hematology ward. Four cases were associated with rapid progression despite piperacillin-tazobactam or meropenem therapy, and three patients developed sepsis or extensive skin/soft tissue necrosis. In three of the four cases, patients were empirically switched from meropenem to ceftolozane/avibactam before carbapenem susceptibility test results were available, and all four patients underwent extensive surgical debridement or amputation of affected tissues and survived. Further investigation revealed a common bathroom source of MDR P. aeruginosa clonal subtypes ST175 and ST235 that harbored genes for type III secretion system expression and elaboration of ExoU or ExoS exotoxin. We conclude that ceftolozane/tazobactam plus early source control was critical for control of rapidly progressing skin and soft infection in these neutropenic patients caused by highly virulent ST175 and ST235 clones of MDR P. aeruginosa. MDPI 2020-12-21 /pmc/articles/PMC7767535/ /pubmed/33371496 http://dx.doi.org/10.3390/microorganisms8122055 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Coppola, Paolo E.
Gaibani, Paolo
Sartor, Chiara
Ambretti, Simone
Lewis, Russell E.
Sassi, Claudia
Pignatti, Marco
Paolini, Stefania
Curti, Antonio
Castagnetti, Fausto
Ursi, Margherita
Cavo, Michele
Stanzani, Marta
Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients
title Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients
title_full Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients
title_fullStr Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients
title_full_unstemmed Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients
title_short Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients
title_sort ceftolozane-tazobactam treatment of hypervirulent multidrug resistant pseudomonas aeruginosa infections in neutropenic patients
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767535/
https://www.ncbi.nlm.nih.gov/pubmed/33371496
http://dx.doi.org/10.3390/microorganisms8122055
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