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Ceftolozane/tazobactam for the treatment of MDR Pseudomonas aeruginosa left ventricular assist device infection as a bridge to heart transplant

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Abstract

Background

Ceftolozane/tazobactam (C/T) is a novel antibiotic with enhanced microbiological activity against multidrug-resistant (MDR) gram-negative bacteria, including MDR Pseudomonas aeruginosa.

Case report

Five months after left ventricular assist device (LVAD) implantation, a 49-year old man developed fever and blood culture was positive for MDR P. aeruginosa, susceptible only to aminoglycosides, ciprofloxacin and colistin. A diagnosis of LVAD-related infection was made based on persistent bacteremia associated with moderate 18 F-fluorodeoxyglucose positron emission tomography/CT uptake in the left ventricular apex. Disk diffusion testing for C/T was performed (MIC 2 μg/mL) and intravenous antibiotic therapy with C/T and amikacin was started, with clinical and microbiological response. Initial conservative management with 6 weeks of systemic antibiotic therapy was attempted, but the patient relapsed one month after antibiotic discontinuation. Priority for transplantation was given and after 4 weeks of antibiotic therapy (C/T + amikacin), LVAD removal and heart transplant were performed, with no infection relapse.

Conclusions

We reported the first off-label use of C/T in the management of MDR P. aeruginosa LVAD infection as a bridge to heart transplant. C/T has shown potent anti-pseudomonal activity and good safety profile making this drug as a good candidate for suppressive strategy in intravascular device-associated bloodstream infections caused by MDR P. aeruginosa.

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Authors and Affiliations

  1. Department of Medicine, Infectious Diseases Clinic, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy

    Maddalena Peghin, Nadia Castaldo, Filippo Givone, Elda Righi & Matteo Bassetti

  2. Cardiothoracic Department, University of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy

    Massimo Maiani, Andrea Lechiancole & Ugolino Livi

  3. Microbiology Unit, Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy

    Assunta Sartor

  4. Institute of Clinical Pharmacology, Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della Misericordia, Udine, Italy

    Federico Pea

Authors
  1. Maddalena Peghin
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  2. Massimo Maiani
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  3. Nadia Castaldo
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  4. Filippo Givone
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  5. Elda Righi
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  6. Andrea Lechiancole
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  7. Assunta Sartor
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  8. Federico Pea
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  9. Ugolino Livi
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  10. Matteo Bassetti
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Corresponding author

Correspondence to Matteo Bassetti.

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Peghin, M., Maiani, M., Castaldo, N. et al. Ceftolozane/tazobactam for the treatment of MDR Pseudomonas aeruginosa left ventricular assist device infection as a bridge to heart transplant. Infection 46, 263–265 (2018). https://doi.org/10.1007/s15010-017-1086-0

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  • DOI: https://doi.org/10.1007/s15010-017-1086-0

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