RESUMO
Extremely drug-resistant (XDR) Acinetobacter baumannii causes challenging nosocomial infections. We report the case of a patient with XDR A. baumannii pneumonia and septic shock successfully treated with cefiderocol and a novel antibiotic obtained via expanded access protocol. With focused research and drug development efforts, the poor outcomes associated with these infections may be mitigated.
Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Infecção Hospitalar , Pneumonia Associada a Assistência à Saúde , Preparações Farmacêuticas , Infecções por Acinetobacter/tratamento farmacológico , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Farmacorresistência Bacteriana Múltipla , Pneumonia Associada a Assistência à Saúde/tratamento farmacológico , Humanos , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: The most recently approved fluoroquinolone for use in the US and Europe, delafloxacin (DLX) provides broad-spectrum coverage, improved side effect profile, and excellent potency. Currently approved for the treatment of acute bacterial skin infections and community-acquired pneumonia, DLX may be useful in the treatment of other infections given the longstanding versatility of other fluoroquinolones. MATERIALS AND METHODS: This is a retrospective review of adult patients treated with DLX at The University of Texas Medical Branch, Galveston, TX from January 1, 2018 to February 1, 2020 using pre-existing electronic medical records. Simple statistics were calculated using Microsoft Excel. RESULTS: Five patients were prescribed DLX (median age 59 years, 40% female, 100% outpatient) with a median treatment duration of seven days. Prescriptions were initiated by infectious diseases specialists (2/5, 40%), emergency medicine physicians (2/5, 40%), and ophthalmologists (1/5, 20%). The most common conditions treated were prosthetic joint infections (PJI) and acute skin and soft tissue infections (each n = 2). Both PJIs were caused by multi-drug-resistant Staphylococcus epidermidis. Off-label utilization was high (3/5, 60%). No patient experienced any documented treatment failure due to delafloxacin and there were zero reported adverse events. CONCLUSIONS: A new antibiotic with valuable characteristics, DLX treatment was highly successful in this case series, including with multiple off-label indications. Real-world clinical data with delafloxacin are currently scant. Prospective data would be useful for identifying future clinical niches for this new fluoroquinolone.
Assuntos
Staphylococcus aureus Resistente à Meticilina , Dermatopatias Bacterianas , Adulto , Antibacterianos/efeitos adversos , Feminino , Fluoroquinolonas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Dermatopatias Bacterianas/microbiologiaRESUMO
Cryptococcus gattii is an underrecognized cause of meningitis, especially in nonendemic regions. This report details C gattii disease progression from admission to autopsy in an otherwise healthy 40-year-old male in Texas. It brings awareness to an often unsuspected organism that can cause severe infection requiring early recognition and treatment in immunocompetent individuals.