A health-care associated pneumonia case due to colistin resistant Acinetobacter baumannii

Yıl 2014, Cilt: 4 Sayı: 03, - , 01.09.2014

Şiran Keske Gul Ruhsar Yilmaz Tumer Guven Rahmet Guner Mehmet Akin Tasyaran

https://doi.org/10.5799/ahinjs.02.2014.03.0150

Cited By: 2

Öz

A 78 year old male was hospitalized in neurology clinic with a diagnosis of encephalopathy. On 13th day of imipenem treatment for ventilator-associated pneumonia (VAP), a new VAP episode was diagnosed based on physical examination, laboratory and radiological findings. Cefoperazone-sulbactam 2x2 gr/day IV was started empirically. In the 3rd day of treatment Acinetobacter baumannii was identified from endotracheal aspirate culture that was resistant to all other antibiotics including colistin except cefoperazone-sulbactam (intermediate) and tigecycline (MIC: 4 mg/L, intermediate) by VITEK and E-test. Tigecycline 2 x 50 mg (after loading dose of 100 mg) IV, colistin IV 2 x 150 mg and colistin inhaler 2 x 75 mg were added to the cefoperazone-sulbactam 2 x 2 gr IV. Clinical findings were improved under this combination and completed to 14 days. The patient was discharged from hospital with neurological sequel after three months. This case has been presented to emphasize that colistin resistant Acinetobacter baumannii is becoming a problem for our country.

Anahtar Kelimeler

Acinetobacter baumannii, colistin resistant, pneumonia, multidrug resistant

A health-care associated pneumonia case due to colistin resistant Acinetobacter baumannii

Öz

Yetmiş sekiz yaşındaki erkek hasta ensefalopati tanısı ile nöroloji bölümüne yatırıldı. Ventilatör ilişkili pnömoni (VİP) nedeniyle başlanan imipenem tedavisinin 13. gününde fizik muayene, laboratuar ve radyolojik bulgulara dayanarak yeni bir VİP tanısı kondu. Ampirik olarak sefoperazon sulbaktam 2 x 2 gr/gün IV tedavisi başlandı. Tedavinin 3. gününde endotrakeal aspirat kültüründe hem Vitek hem de e-testle sefoperazon-sulbaktam (orta duyarlı) ve tigesiklin (MIC: 4 mg/L, orta duyarlı) hariç diğer tüm antibiyotiklere (kolistin dahil) dirençli Acinetobacter baumannii üremesi oldu. Sefoperazon-sulbaktam 2 x 2 gr/gün IV tedavisine tigesiklin 2 x 50 mg/gün (100 mg yükleme dozunu takiben) IV, kolistin 2 x 150 mg/gün IV ve kolistin 2 x 75 mg/gün inhaler eklendi. Bu kombinasyon tedavisi altında hastada klinik yanıt alındı ve tedavi 14 güne tamamlandı. Hasta 3 ay sonra nörolojik sekel ile hastaneden taburcu edildi. Bu olgu kolistin dirençli Acinetobacter baumannii olgularının ülkemiz için bir sorun haline gelmeye başladığını göstermek amacıyla sunulmaktadır

Anahtar Kelimeler

Acinetobacter baumannii, kolistin direnci, pnömoni, çoklu ilaç direnci

Kaynakça

• Li J, Nation RL, Turnidge JD, et al. Colistin: the re-emerging antibiotic for multidrug-resistant gram-negative bacterial in- fections. Lancet Infect Dis 2006; 6:589–601.
• Gilad J, Eskira S, Riesenberg K, et al. Emergence of noso- comial colistin-resistant Acinetobacter baumannii [abstract K-1292]. In: Program and abstracts of the 45th Annual In- terscience Conference on Antimicrobial Agents and Che- motherapy (ICAAC). Washington DC: American Society for Microbiology, 2005:333.
• Rahal JJ. Novel antibiotic combinations against infections with almost completely resistant Pseudomonas aeruginosa and Acinetobacter species. Clin Infect Dis 2006;43 (Suppl. 2):S95-9.
• Navon-Venezia S, Leavitt A, Carmeli Y. High tigecycline re- sistance in multidrug-resistant Acinetobacter baumannii. J Antimicrob Chemother 2007;59:772-774.
• Montero A, Ariza J, Corbella X, et al. Antibiotic combinations for serious infections caused by carbapenem-resistant Aci- netobacter baumannii in a mouse pneumonia model. J Anti- microb Chemother 2004;54:1085-1091.
• Kalin G, Alp E, Akin A, et al. Comparison of colistin and colistin/ sulbactam for the treatment of multidrug resistant Acineto- bacter baumannii ventilator-associated pneumonia. Infection 2014;42:37-42.
• Matthaiou KD, Michalopoulos A, Rafailidis P, et al. Risk fac- tors associated with the isolation of colistin-resistant Gram- negative bacteria: a matched case-control study. Crit Care Med 2008;36:807-811.
• Rolain JM, Roch A, Castanier M, Papazian L, Raoult D. Aci- netobacter baumannii resistant to colistin with impaired viru- lence: a case report from France. J Infect Dis 2011;204:1146- 1147.
• Dizbay M, Tozlu DK, Cirak MY, et al. In vitro synergistic activity of tigecycline and colistin against XDR-Acinetobacter bau- mannii. J Antibiot (Tokyo) 2010;63:51-53.
• Mutlu Yilmaz E, Sunbul M, Aksoy A, et al. Efficacy of tige- cycline/colistin combination in a pneumonia model caused by extensively drug- resistant Acinetobacter baumannii. Int J Antimicrob Agents 2012;40:332-336.