Successful ceftazidime‐avibactam treatment of post‐surgery Burkholderia multivorans genomovar II bacteremia and brain abscesses in a young lung transplanted woman with cystic fibrosis

Abstract

Burkholderia cepacia complex (Bcc) includes several phenotypically similar but genotypically distinct gram‐negative bacteria (GNB) that can colonize the respiratory tract of Cystic Fibrosis (CF) patients. Pathogens are difficult to treat due to intrinsic resistance to multiple antibiotics and are associated to a more rapid decline in lung function and to increased mortality, particularly after lung transplantation. For all these reasons, chronic infection by Burkholderia (B) cenocepacia is presently considered a relative or absolute contraindication in almost all lung transplant centres. We report the case of a young adult CF patient chronically colonized by B multivorans genomovar II, with diabetes and end‐stage renal disease treated with renal replacement therapy: a few months after lung transplantation, she developed post‐surgery B multivorans bacteremia and multiple brain abscesses. This severe infection did not improve despite multiple standard antibiotic regimen. The introduction of ceftazidime‐avibactam, a new β‐lactam/ β‐lactamase inhibitor combination resulted in clinical recovery and in radiological and biochemical improvement.

Inhibition Activity of Avibactam against Nocardia farcinica β-Lactamase FAR IFM10152

“…Avibactam penetration in rabbit CSF is about 38% (16). Six case reports have described the successful use of intravenous ceftazidime/avibactam for the treatment of CNS infections caused by multidrug-resistant bacteria (17)(18)(19)(20)(21)(22). Even if obvious publication bias may preclude the identification of therapeutic failure of avibactamcontaining regimens for CNS infections, these data suggest that avibactam penetration in CSF is sufficient for in situ ␤-lactamase inhibition.…”

Bacterial infections in lung transplantation

“…Drugs that have been approved for treatment of certain CRE infections include ceftazidime-avibactam, meropenem-vaborbactam, cefiderocol, and plazomicin. Ceftazidime-avibactam has been used successfully to treat a LTR with CF who developed Bulkholderia multivorans bacteremia and brain abscess (165). It is important that labs have the capability to perform susceptibility testing with established phenotypic tests or multiplex PCR methods for detection of the various β-lactamases.…”

The Impact of Resistant Bacterial Pathogens including Pseudomonas aeruginosa and Burkholderia on Lung Transplant Outcomes

“…53,67 The Impact of Resistant Bacterial Pathogens Mitchell, Glanville potentially fatal, such as Pseudomonas-related aortic aneurysm and multiple cerebral abscesses following bacteremia with B. multivorans genomovar II. 68,69 Other critical cerebral complications include subdural empyema and ocular complications include endophthalmitis and subretinal abscess. [70][71][72][73] Within the thorax, mediastinal abscess due to B. gladioli infection and suppurative mediastinitis with B. cepacia can be difficult to treat.…”

“…Among these combinations, colistin and ceftazidime-avibactam with or without ceftolozane-tazobactam have been reported successful for BCC even with disseminated disease. 69,[93][94][95] The rationale for using avibactam is that it restores susceptibility to ceftazidime for BCC isolates. 96 Precise surgical techniques have been described especially for B. cenocepacia and include irrigation of the chest cavity and bronchi with 0.5% povidone-iodine solution or taurolidine.…”