title: [Successful combination therapy by meropenem and colistin for multi-drug-resistant Pseudomonas aeruginosa infection after allogeneic bone marrow transplantation].
abstract: A 66-year-old male with acute type adult T-cell leukemia that was refractory to chemotherapy underwent unrelated allogeneic bone marrow transplantation after non-myeloablative conditioning with fludarabine, busulfan and total body irradiation. During an episode of neutropenia on day 12 after transplantation, pneumonia and sepsis due to multi-drug resistant Pseudomonas aeruginosa developed. Drug susceptibility tests demonstrated resistance to all kinds of intravenous antibiotics available for P. aeruginosa in Japan. Multi-drug susceptibility tests by the breakpoint-checkerboard plate method were then performed and combination therapy with meropenem hydrate and colistin was started based on the test results. After starting treatment, clinical symptoms and laboratory data immediately improved and engraftment of neutrophils was achieved on day 18. Infections with multi-drug-resistant P. aeruginosa are often critical for patients after hematopoietic stem cell transplantation and are difficult to control. In this paper, we report a case of severe multi-drug-resistant P. aeruginosa infection that was successfully treated by combination therapy selected using the breakpoint-checkerboard plate method.
authors.affiliation: Hematopoietic Stem Cell Transplantation Center, Department of Clinical Laboratory and Transfusion, Hokkaido University Hospital.
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Kanda
authors.forename: Akio
authors.initials: A
authors.lastname: Shigematsu
authors.forename: Kohei
authors.initials: K
authors.lastname: Okada
authors.forename: Ikumi
authors.initials: I
authors.lastname: Kasahara
authors.forename: Junko
authors.initials: J
authors.lastname: Iwasaki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Yamaguchi
authors.forename: Masahiro
authors.initials: M
authors.lastname: Onozawa
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Endo
authors.forename: Koji
authors.initials: K
authors.lastname: Akizawa
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Ishiguro
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hashino
authors.forename: Masahiro
authors.initials: M
authors.lastname: Imamura
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D003091:Colistin / Q000494:pharmacology / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D006801:Humans; D008297:Male; D000077731:Meropenem; D008826:Microbial Sensitivity Tests / Q000379:methods; D009503:Neutropenia / Q000209:etiology; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D013845:Thienamycins / Q000494:pharmacology / Q000627:therapeutic use*; D014184:Transplantation, Homologous; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D013845:Thienamycins; D000077731:Meropenem; D003091:Colistin