349. Hardware-Associated Multidrug-resistant Pseudomonas aeruginosa Meningitis Treated with Ceftolozane-Tazobactam

BACKGROUND: Although new treatment options for resistant gram negative rods have been recently developed, data on the use of these novel antibiotics for the treatment of central nervous system (CNS) infections is limited. METHODS: We present the case of a 9-year-old with a complex medical history including cerebral palsy and ventriculoperitoneal shunt dependence who was found to have highly resistant Pseudomonas aeruginosa growing from multiple cerebrospinal fluid (CSF) cultures. Susceptibility testing revealed resistance to multiple classes of antibiotics including carbapenems. Multiple antibiotics were considered for treatment; factors including molecular size, lipophilicity, plasma protein binding, and active transport as well as previously published data were weighed in selecting an antibiotic. RESULTS: The patient was treated with 28 days of ceftolozane-tazobactam. CSF cultures cleared following externalization of the ventriculoperitoneal shunt to an external ventricular drain. There was no recrudescence of Pseudomonas aeruginosa in the CSF following clearance. CONCLUSION: We present the first reported case of ceftolozane-tazobactam used as the sole agent for treatment of resistant gram negative rod infection in the CNS. This agent may be a reasonable choice for other patients requiring treatment of highly resistant infections in this protected space. DISCLOSURES: Ofer Levy, MD, PhD, Avidea (Other Financial or Material Support, collaboration)Exicure (Other Financial or Material Support, collaboration)Multiple patents (Other Financial or Material Support, I am a named inventor on patents related to vaccine adjuvants)