Carbapenem-Resistant Pseudomonas aeruginosa Spondylodiscitis Treated with Ceftazidime-Avibactam: A Case Report with Literature Review

Abstract

Pyogenic spondylodiscitis (PS) is a highly morbid and potentially fatal bacterial infection with an increasing incidence in recent decades. Its diagnosis and treatment are challenging, especially with the expansion of multidrug- or extensively drug-resistant bacteria. We report a rare case of PS caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) that was treated with ceftazidime-avibactam (C/A). The choice of C/A therapy was based on the patient’s bacterial sensitivity profile and intolerance to the initial therapeutic regimen (polymyxin B and meropenem). The total antimicrobial treatment time was seven weeks. The evolution of the clinical course met the cure criteria, which was characterized by remission of signs and symptoms, normalization of inflammatory markers, and radiological improvement over 18 months of clinical follow-up. This is a rare case of CRPA spondylodiscitis that responded to C/A treatment.

Keywords:

• antibiotic
• β-lactam/β-lactamase inhibitor
• resistance
• vertebral osteomyelitis
• bone and joint infection

Abbreviations

C/A, ceftazidime-avibactam; CR-KP, carbapenem-resistant Klebsiella pneumonia; CRP, C-reactive-protein; CRPA, carbapenem-resistant Pseudomonas aeruginosa; CT, computed tomography; ESBL, extended-spectrum β-lactamase; ESR, erythrocyte sedimentation rate; GNB, Gram-negative bacilli; HAIs, healthcare-associated infections; IV, intravenous; KPC, Klebsiella pneumoniae carbapenemases; MBL, metallo-β-lactamase; MDR, multidrug-resistant; MIC, minimum inhibitory concentration; MRI, magnetic resonance imaging; MRSA, methicillin-resistant Staphylococcus aureus; PS, pyogenic spondylodiscitis; XDR, extensively drug-resistant.

Data Sharing Statement

The data used and analyzed in this report are available from the corresponding author upon reasonable request.

Ethics Approval and Informed Consent

The present study was submitted to and approved by the Human Research Ethics Committee of the SARAH Network of Rehabilitation Hospitals under protocol CAAE: 69132123.3.0000.0022 and is in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration. The patient signed the informed consent form for publication of the case details and any accompanying images.

Acknowledgments

The authors are grateful to their colleagues for the management of the patient and to the subject for participating in this study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.