Infection

, Volume 46, Issue 2, pp 263–265 | Cite as

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

  • Maddalena Peghin
  • Massimo Maiani
  • Nadia Castaldo
  • Filippo Givone
  • Elda Righi
  • Andrea Lechiancole
  • Assunta Sartor
  • Federico Pea
  • Ugolino Livi
  • Matteo Bassetti
Case Report

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.

Keywords

Ceftolozane/tazobactam MDR Pseudomonas aeruginosa Left ventricular assist device infection Heart transplant Device infections MDR gram negative bacteria 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Maddalena Peghin
    • 1
  • Massimo Maiani
    • 2
  • Nadia Castaldo
    • 1
  • Filippo Givone
    • 1
  • Elda Righi
    • 1
  • Andrea Lechiancole
    • 2
  • Assunta Sartor
    • 3
  • Federico Pea
    • 4
  • Ugolino Livi
    • 2
  • Matteo Bassetti
    • 1
  1. 1.Department of Medicine, Infectious Diseases ClinicUniversity of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della MisericordiaUdineItaly
  2. 2.Cardiothoracic DepartmentUniversity of Udine and Azienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della MisericordiaUdineItaly
  3. 3.Microbiology UnitAzienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della MisericordiaUdineItaly
  4. 4.Institute of Clinical PharmacologyAzienda Sanitaria Universitaria Integrata Presidio Ospedaliero Universitario Santa Maria della MisericordiaUdineItaly

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