Assuntos
Carbapenêmicos , Pancreatite Necrosante Aguda , Humanos , Carbapenêmicos/uso terapêutico , Pancreatite Necrosante Aguda/tratamento farmacológico , Antibacterianos/uso terapêutico , Proteínas de Bactérias , Estudos Prospectivos , Combinação de Medicamentos , Testes de Sensibilidade Microbiana , CeftazidimaRESUMO
With limited and often toxic treatment options, carbapenem-resistant Gram-negative infections are associated with significant mortality. Cefepime-zidebactam is a promising antibiotic option undergoing a phase 3 trial that has activity against diverse antibiotic-resistant mechanisms in Gram-negative pathogens due to its ß-lactam enhancer mechanism, mediating multiple PBP binding. We report a case of disseminated infection caused by a New Delhi metallo-ß-lactamase-producing, extensively drug-resistant Pseudomonas aeruginosa isolate in a patient with acute T-cell leukemia, successfully managed with cefepime-zidebactam as a salvage therapy.
Assuntos
Leucemia-Linfoma Linfoblástico de Células T Precursoras , Infecções por Pseudomonas , Adulto , Humanos , Pseudomonas aeruginosa/metabolismo , Infecções por Pseudomonas/tratamento farmacológico , Terapia de Salvação , Cefalosporinas/uso terapêutico , Antibacterianos/uso terapêutico , beta-Lactamases/genética , beta-Lactamases/metabolismo , Compostos Azabicíclicos/uso terapêutico , Testes de Sensibilidade MicrobianaRESUMO
Cryptococcal meningitis is a life-threatening infection commonly seen in patients with advanced HIV infection and solid organ transplant recipients. We report a case of cryptococcal meningitis with immune reconstitution syndrome (IRIS) who presented to us with a headache and complete loss of vision in the left eye. He was managed with antifungals and a short course of steroids, and he regained vision completely. In the hospital, he developed complications including tacrolimus toxicity, fluconazole-induced QT prolongation, and flucytosine-induced thrombocytopenia. Our case demonstrates the importance of a multidisciplinary approach in the management of complex cases like cryptococcal meningitis in solid organ transplant recipients.