title: A novel combination regimen for the treatment of refractory bacteremia due to multidrug-resistant Pseudomonas aeruginosa in a liver transplant recipient.
abstract: Both bacteremia and biliary cast syndrome are serious post-transplant complications in liver transplant recipients. In the setting of increasing drug resistance in the current era, management of infections caused by multidrug-resistant (MDR) bacteria has proven challenging. We present a case of a liver transplant recipient who developed biliary cast syndrome and intractable MDR Pseudomonas bacteremia that failed to resolve with conventional antimicrobial therapy and which was finally controlled by a novel combination regimen of colistimethate, doripenem, and tobramycin. Future studies validating the clinical efficacy of this combination strategy are warranted.
authors.affiliation: VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA.
authors.forename: H-Y
authors.initials: HY
authors.lastname: Sun
authors.forename: R K
authors.initials: RK
authors.lastname: Shields
authors.forename: T V
authors.initials: TV
authors.lastname: Cacciarelli
authors.forename: R R
authors.initials: RR
authors.lastname: Muder
authors.forename: N
authors.initials: N
authors.lastname: Singh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D001649:Bile Duct Diseases / Q000188:drug therapy / Q000382:microbiology; D015780:Carbapenems / Q000627:therapeutic use; D003091:Colistin / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077726:Doripenem; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D014031:Tobramycin / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D000077726:Doripenem; C004691:colistinmethanesulfonic acid; D014031:Tobramycin; D003091:Colistin