title: [Infection treatment caused by multiple-drug-resistant Pseudomonas aeruginosa in a patient undergoing allogeneic hematopoietic stem cell transplantation].
abstract: Infections caused by multiple-drug-resistant Pseudomonas aeruginosa (MDRP) are a clinically significant problem. We reported here the effective use of combination therapy in a patient with infection caused by MDRP according to an interventional treatment strategy suggested by a pharmacist. The patient was a 70-year-old male who underwent allogeneic hematopoietic stem cell transplantation. On day 45 after transplant, MDRP was newly isolated from urine, but the diagnosis at that time was colonization. On day 61, the patient developed a fever (> or =38.0 degrees C). In addition, laboratory data showed that C-reactive protein (CRP) was also increased. At the medical team conference, the pharmacist proposed the following treatment strategy for this infection. Aztreonam and amikacin were intravenously administered at doses of 2 g/day and 800 mg/day, respectively. The subsequent clinical course was well controlled, but the infection recurred and was aggravated. Aztreonam and ciprofloxacin were then intravenously administered at doses of 4 g/day and 600 mg/day, respectively, resulting in the alleviation of fever in the patient as well as a decrease in CRP and disappearance of MDRP isolates from urine on day 67; that is, MDRP infection was consequently well controlled. In conclusion, the combination therapy between aztreonam and amikacin, or ciprofloxacin may be clinically useful for severe infections of MDRP in compromised hosts.
authors: Department of Pharmacy, Kagawa University Hospital, Faculty of Medicine, Kagawa University, Kagawa, Japan. k-hitoshi@umin.net
authors: Hitoshi
authors: H
authors: Kawazoe
authors: Yoshiharu
authors: Y
authors: Takiguchi
authors: Tatsuya
authors: T
authors: Inoue
authors: Kazunori
authors: K
authors: Yamaguchi
authors: Hiroaki
authors: H
authors: Tanaka
authors: Masato
authors: M
authors: Kaji
authors: Shigeko
authors: S
authors: Tsuji
authors: Masaki
authors: M
authors: Ninomiya
authors: Noriyasu
authors: N
authors: Fukuoka
authors: Hiroaki
authors: H
authors: Ohnishi
authors: Toshihiko
authors: T
authors: Ishida
authors: Hitoshi
authors: H
authors: Houchi
mesh_terms: D000368:Aged; D000583:Amikacin / Q000008:administration & dosage*; D001398:Aztreonam / Q000008:administration & dosage*; D002939:Ciprofloxacin / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016867:Immunocompromised Host; D007262:Infusions, Intravenous; D008297:Male; D011552:Pseudomonas Infections / Q000188:drug therapy*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D002939:Ciprofloxacin; D000583:Amikacin; D001398:Aztreonam