Onset of Life-Threatening Ventriculitis During Ceftazidime Therapy for Nosocomial Pneumonia Due to Enterobacter cloacae

Land, G.L.; Salgado, J.R.; Greenberg, Richard N.

doi:10.1093/clinids/17.2.295

Cited by 5 publications

(2 citation statements)

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“…Of interest, clinically significant emergence of resistance to ceftazidime in Enterobacter species has been reported previously and has been attributed to production of type I chromosomally mediated ␤-lactamases. [6][7][8] We found an association between the use of ceftazidime, gentamicin, ticarcillin-clavulanate, or tobramycin and loss of susceptibility to the same antibiotics in repeat isolates. Use of ticarcillin-clavulanate for у3 days was associated with increasing resistance to ceftazidime, aztreonam, and ceftriaxone even though, except for one instance, it was not used concurrently with these antibiotics.…”

Section: Discussionmentioning

confidence: 73%

Loss of Antimicrobial Susceptibility in Aerobic Gram-Negative Bacilli Repeatedly Isolated From Patients in Intensive-Care Units

Manian

Meyer

Jenne

et al. 1996

Infect. Control Hosp. Epidemiol.

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Objective:To study the loss of antimicrobial susceptibility in repeat (same patient, same bacterial species, and same site) aerobic gram-negative bacilli (AGNB) isolated from individual patients during their stay in the intensive-care unit (ICU).Setting:A 792-bed, tertiary-care community hospital with a total of 107 adult, pediatric, and neonatal ICU beds. METHOD: An obser vational prospective study performed November 1992 through mid-July 1993.Results:Of 594 consecutive AGNB from 287 ICU patients, 117 isolates (20%) from 55 patients (19%) were repeat isolates, with the majority obtained from respiratory secretions (83%). Pseudomonas aeruginosa and Enterobacter species accounted for 61% of the isolates. Forty-two (36%) of the repeat isolates from 24 patients (44%) had >4-fold increase in minimum inhibitory concentration to at least one antibiotic and no longer were considered fully susceptible based on National Committee on Clinical Laboratory Standards criteria. Loss of antimicrobial susceptibility often developed within several (median 8) days and was associated only infrequently with simultaneous transition from colonization to infection in the individual patient. Use of certain β-lactam antibiotics was associated with increasing resistance to several other antibiotics in the same class. Concurrent use of β-lactams and aminoglycosides did not prevent loss of antimicrobial susceptibility to the former in repeat isolates.Conclusion:We conclude that loss of antimicrobial susceptibility in repeat AGNB isolated from ICU patients is common, usually is not associated with transition from colonization to infection, and often is associated with prior use of antibiotics. Minimizing antibiotic use in ICU patients should help reduce the risk of antimicrobial resistance in repeat AGNB isolates.

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Section: Discussionmentioning

confidence: 73%

Loss of Antimicrobial Susceptibility in Aerobic Gram-Negative Bacilli Repeatedly Isolated From Patients in Intensive-Care Units

Manian

Meyer

Jenne

et al. 1996

Infect. Control Hosp. Epidemiol.

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“…The bacteremia is noted as transient due to negative blood cultures taken five days prior to diagnosing the latter ventriculitis. A case report involving Enterobacter cloacae illustrated a clinical scenario similar to ours, with possible hematogenous spread from an initial pneumonia to a subsequent ventriculitis, with sputum and CSF cultures showing the same microorganism while blood cultures yielded no growth [ 18 ]. The transient nature of the proposed bacteremia could be explained by the prophylactic systemic antibiotics (PSAs) routinely given throughout the duration of EVDs [ 19 ].…”

Section: Discussionmentioning

confidence: 96%

Catheter-Associated Vancomycin-Resistant Enterococcus faecium Ventriculitis and Multidrug-Resistant Acinetobacter baumannii Pneumonia With Subsequent Acinetobacter Ventriculitis: A Case Report

Rei,

Reddy,

Andraos

et al. 2023

Cureus

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Ventriculitis is associated with cerebrospinal fluid (CSF) shunts, and rare microorganisms associated with infection include vancomycin-resistant Enterococcus (VRE) faecium and Acinetobacter baumannii . Both organisms are known to cause nosocomial infections, and the emergence of multidrug-resistant (MDR) strains presents a treatment challenge. There is a lack of consensus on antimicrobial agent selection for ventriculitis involving VRE faecium or MDR A. baumannii , which are life-threatening conditions. We present a case of a 59-year-old male presenting with CSF catheter-associated VRE faecium ventriculitis and MDR A. baumannii pneumonia who subsequently developed a nosocomial MDR A. baumannii ventriculitis. Both instances of ventriculitis were successfully treated with combination antibiotic therapy. VRE faecium ventriculitis was successfully treated with linezolid and intrathecal daptomycin. While daptomycin is not approved for Enterococcal infections, the synergistic effect of daptomycin in combination with linezolid proved effective. Although the MDR A. baumannii pneumonia was not cured with cefiderocol monotherapy, the MDR A. baumannii ventriculitis was successfully treated with combination therapy including cefiderocol, ampicillin/sulbactam, and intrathecal colistin. This highlights life-saving combination antibiotic therapies for ventriculitis caused by multiple rare and drug-resistant microorganisms.

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Comparison of antimicrobial efficacy of a fixed dose combination of ceftazidime + sulbactam with ceftazidime and sulbactam alone against five bacteria

2009

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The efficacy of the agents was evaluated on the basis of minimum inhibitory concentration (MIC) and time-kill curve analysis in Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter baumannii, Mycobacterium smegmatis, and Citrobacter braakii; MIC was found to be 0.5, 4.0, 0.015625, 0.0078125, and 0.0625 mg/L in FDC of ceftazidime + sulbactam, respectively, which is lower than ceftazidime and sulbactam individually. Time-kill curve analysis demonstrated maximum killing of bacteria after 4 h. A fixed dose combination of ceftazidime + sulbactam was found to have stronger antibacterial properties than ceftazidime and sulbactam alone at in vitro analysis.

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Onset of Life-Threatening Ventriculitis During Ceftazidime Therapy for Nosocomial Pneumonia Due to Enterobacter cloacae

Cited by 5 publications

References 0 publications

Loss of Antimicrobial Susceptibility in Aerobic Gram-Negative Bacilli Repeatedly Isolated From Patients in Intensive-Care Units

Loss of Antimicrobial Susceptibility in Aerobic Gram-Negative Bacilli Repeatedly Isolated From Patients in Intensive-Care Units

Catheter-Associated Vancomycin-Resistant Enterococcus faecium Ventriculitis and Multidrug-Resistant Acinetobacter baumannii Pneumonia With Subsequent Acinetobacter Ventriculitis: A Case Report

Comparison of antimicrobial efficacy of a fixed dose combination of ceftazidime + sulbactam with ceftazidime and sulbactam alone against five bacteria

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