title: Treatment of multidrug-resistant pseudomonas aeruginosa using extended-infusion antimicrobial regimens.
abstract: In the management of multidrug-resistant infections in critically ill patients with multiorgan dysfunction, consideration must be given to the pharmacokinetics and pharmacodynamics of an antimicrobial agent to optimize dosing. We describe a 25-year-old woman who was undergoing thrice-weekly hemodialysis and developed multidrug-resistant Pseudomonas aeruginosa bacteremia secondary to infected left and right ventricular assist devices. After multiple courses of antibiotics, her blood cultures revealed that the infecting organism was becoming progressively more resistant to antibiotic options. Cefepime 2 g administered over 3 hours/day (in combination with colistimethate) provided adequate drug levels for multidrug-resistant, cefepime-intermediate P. aeruginosa bacteremia in this patient. We present the clinical case of this patient, followed by a discussion of possible therapeutic approaches to be considered, including illustration of the principles of using extended-infusion antimicrobial regimens, and present the patient's resulting clinical course.
authors.affiliation: Department of Pharmacy, University of Maryland Medical Center, Baltimore, Maryland.
authors.forename: Emily L
authors.initials: EL
authors.lastname: Heil
authors.forename: Ashleigh V
authors.initials: AV
authors.lastname: Lowery
authors.forename: Kerri A
authors.initials: KA
authors.lastname: Thom
authors.forename: David P
authors.initials: DP
authors.lastname: Nicolau
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage* / Q000097:blood / Q000627:therapeutic use; D003091:Colistin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000097:blood / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D006353:Heart-Assist Devices / Q000382:microbiology; D006801:Humans; D007262:Infusions, Intravenous; D008657:Metabolic Clearance Rate; D008826:Microbial Sensitivity Tests; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000209:etiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D000077723:Cefepime; C004691:colistinmethanesulfonic acid; D003091:Colistin
keywords: Pseudomonas; cefepime; multidrug-resistant