Treatment of recurrent Stenotrophomonas maltophilia ventilator-associated pneumonia with doxycycline and aerosolized colistin
| Autor: | Timothy C. Fabian, G. Christopher Wood, Elizabeth L. Underwood, Joseph M. Swanson, Martin A. Croce |
|---|---|
| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Stenotrophomonas maltophilia urologic and male genital diseases Anti-Infective Agents Drug Resistance Multiple Bacterial Administration Inhalation Trimethoprim Sulfamethoxazole Drug Combination medicine Pneumonia Bacterial Humans Pharmacology (medical) Antibacterial agent Doxycycline Aerosols biology business.industry Colistin Sulfamethoxazole Ventilator-associated pneumonia Pneumonia Ventilator-Associated biochemical phenomena metabolism and nutrition bacterial infections and mycoses medicine.disease biology.organism_classification Trimethoprim respiratory tract diseases Surgery Anti-Bacterial Agents Pneumonia Anesthesia Injections Intravenous bacteria Drug Therapy Combination business Gram-Negative Bacterial Infections medicine.drug |
| Zdroj: | The Annals of pharmacotherapy. 44(10) |
| ISSN: | 1542-6270 |
| Popis: | To report a case of recurrent Stenotrophomonas maltophilia ventilator-associated pneumonia (VAP) that was successfully treated with doxycycline and aerosolized colistin.A 28-year-old male was admitted with a severe head injury and required mechanical ventilation. The patient developed S. maltophilia VAP on hospital day 17, which was cured after 7 days of treatment with high-dose intravenous trimethoprim/sulfamethoxazole (TMP/SMX). However, on day 34, the patient developed recurrent S. maltophilia VAP that did not respond clinically or demonstrate eradication on follow-up culture after 10 days of TMP/SMX. At that time, TMP/SMX was discontinued and treatment was initiated with intravenous doxycycline and aerosolized colistin. The VAP episode was cured after 14 days of treatment with doxycycline/aerosolized colistin.S. maltophilia is an emerging cause of VAP in some centers. This organism is associated with high mortality rates and has few treatment options because it is intrinsically resistant to most drug classes. Recent data suggest that doxycycline and aerosolized colistin each are effective in treatment of other multidrug-resistant organisms, such as Pseudomonas aeruginosa and Acinetobacter baumannii. However, this is the first report describing the use of this antibiotic regimen for S. maltophilia. High-dose TMP/SMX is considered to be the drug of choice primarily based on excellent in vitro activity. Few data exist on how to treat patients who fail therapy with TMP/SMX or cannot receive that drug because of resistance, allergy, or adverse events. Thus, it is important to report alternative methods for treating this infection.The positive clinical response to doxycycline and aerosolized colistin seen in the patient described here suggests that this combination may be an alternative treatment in patients who fail initial treatment or cannot receive standard therapies. |
| Databáze: | OpenAIRE |
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