Bloodstream Infection due to Piperacillin/Tazobactam Non-Susceptible, Cephalosporin-Susceptible Escherichia coli: A Missed Opportunity for De-Escalation of Therapy
Bloodstream Infection due to Piperacillin/Tazobactam Non-Susceptible, Cephalosporin-Susceptible Escherichia coli: A Missed Opportunity for De-Escalation of Therapy
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DOI：
10.3390/antibiotics7040104
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发表时间：
2018-12-01
影响因子：
4.8
通讯作者：
Al-Hasan, Majdi N.
中科院分区：
文献类型：
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作者：
Carlisle, Leah;Justo, Julie Ann;Al-Hasan, Majdi N.
越来越多的报告描述了具有哌拉西林/他唑巴坦耐药性的大肠埃希菌分离株，尽管保留了头孢菌素的敏感性，表明这种表型耐药模式的进一步出现。在这篇报告中，一位转移性乳癌的病人在两天后出现寒战、恶心、呕吐、减少口服摄入量和全身无力而就诊。血和尿培养显示E.大肠杆菌，分别用快速诊断多重PCR和MALDI-TOF鉴定。尽管使用静脉内哌拉西林/他唑巴坦进行经验性抗菌治疗，但患者在住院的前三天继续表现出脓毒症伴低血压和呼吸急促的体征。体外抗菌药物敏感性试验显示哌拉西林/他唑巴坦最小抑菌浓度（MIC）为64，头孢曲松MIC为1 mcg/mL后，抗菌治疗从静脉注射哌拉西林/他唑巴坦转为头孢曲松。所有感染症状和体征在开始头孢曲松治疗后48小时内消退。本文报道了哌拉西林/他唑巴坦治疗由大肠杆菌引起的血流感染的临床失败。大肠杆菌，其具有分离的哌拉西林/他唑巴坦不敏感的表型耐药模式。该病例证明了头孢菌素作为潜在治疗选择的作用，并强调了基于微生物鉴定快速诊断检测的抗菌治疗早期降级的价值。
An increasing number of reports describing Escherichia coli isolates with piperacillin/tazobactam resistance, despite retained cephalosporin susceptibility, suggest further emergence of this phenotypic resistance pattern. In this report, a patient with metastatic breast cancer presented to medical care after two days of chills, nausea, vomiting, reduced oral intake, and generalized weakness. Blood and urine cultures grew E. coli as identified by rapid diagnostics multiplex PCR and MALDI-TOF, respectively. The patient continued to manifest signs of sepsis with hypotension and tachypnea during the first three days of hospitalization despite empirical antimicrobial therapy with intravenous piperacillin/tazobactam. After in vitro antimicrobial susceptibility testing demonstrated a piperacillin/tazobactam minimal inhibitory concentration (MIC) of 64 and a ceftriaxone MIC of 1 mcg/mL, antimicrobial therapy was switched from intravenous piperacillin/tazobactam to ceftriaxone. All symptoms and signs of infection resolved within 48 h of starting ceftriaxone therapy. This report describes the clinical failure of piperacillin/tazobactam in the treatment of a bloodstream infection due to E. coli harboring a phenotypic resistance pattern of isolated piperacillin/tazobactam non-susceptibility. The case demonstrates the role of cephalosporins as potential treatment options and highlights the value of early de-escalation of antimicrobial therapy based on rapid diagnostic testing for microbial identification.