Aurélien Dinh1, Benjamin Davido1, Ruxandra Calin1, Julie Paquereau2, Clara Duran1, Frédérique Bouchand3, Véronique Phé4, Emmanuel Chartier-Kastler4, Martin Rottman5, Jérôme Salomon1,6, Patrick Plésiat7, Anaïs Potron7. 1. Infectious Disease Unit, Raymond Poincaré University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France. 2. Physical Medicine And Rehabilitation Department, Raymond Poincaré University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France. 3. Pharmacy Department, Raymond Poincaré University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France. 4. Urology Department, Pitié Salpêtrière University Hospital, AP-HP, Paris, France. 5. Microbiology Laboratory, Raymond Poincaré University Hospital, AP-HP, Versailles Saint Quentin University, Garches, France. 6. UMR 1181, Inserm, Institut Pasteur, Paris, France. 7. French National Reference Centre for Antibiotic Resistance, University Hospital of Besançon, Besançon, France.
Abstract
INTRODUCTION: Urinary tract infections (UTI) are a major public health problem among spinal cord injury (SCI) patients. They frequently involve multidrug-resistant (MDR) bacteria. Ceftolozane/tazobactam (C/T) is a novel antibiotic combination approved for complicated intra-abdominal and UTI caused by Gram-positive and Gram-negative organisms, including some MDR strains. Little is known about the use of this agent for complicated febrile UTI occurring among SCI patients with neurogenic bladder due to MDR Pseudomonas aeruginosa (PSA). CASE PRESENTATION: We describe the case of a 35-year-old man with SCI due to multiple sclerosis, with a neurogenic bladder necessitating a bilateral nephrostomy and double J catheter, who developed a febrile UTI due to a MDR PSA, which was susceptible only to amikacin and colistin. Because of this MDR phenotype and the underlying kidney disease, a 1000 mg (1000 mg per 500 mg) dose of C/T was given as monotherapy every 8 h for 7 days, after 3 days of colistin and amikacin. Thanks to this treatment, the patient had a favorable outcome with no clinical signs of UTI or positive urine culture up to 1 month after diagnosis. DISCUSSION: C/T seems to be an effective and safe therapeutic option for febrile UTI due to MDR PSA in SCI patients with neurogenic bladder, even when administered in monotherapy for 10 days.
INTRODUCTION:Urinary tract infections (UTI) are a major public health problem among spinal cord injury (SCI) patients. They frequently involve multidrug-resistant (MDR) bacteria. Ceftolozane/tazobactam (C/T) is a novel antibiotic combination approved for complicated intra-abdominal and UTI caused by Gram-positive and Gram-negative organisms, including some MDR strains. Little is known about the use of this agent for complicated febrile UTI occurring among SCI patients with neurogenic bladder due to MDR Pseudomonas aeruginosa (PSA). CASE PRESENTATION: We describe the case of a 35-year-old man with SCI due to multiple sclerosis, with a neurogenic bladder necessitating a bilateral nephrostomy and double J catheter, who developed a febrile UTI due to a MDR PSA, which was susceptible only to amikacin and colistin. Because of this MDR phenotype and the underlying kidney disease, a 1000 mg (1000 mg per 500 mg) dose of C/T was given as monotherapy every 8 h for 7 days, after 3 days of colistin and amikacin. Thanks to this treatment, the patient had a favorable outcome with no clinical signs of UTI or positive urine culture up to 1 month after diagnosis. DISCUSSION: C/T seems to be an effective and safe therapeutic option for febrile UTI due to MDR PSA in SCI patients with neurogenic bladder, even when administered in monotherapy for 10 days.
Authors: A Dinh; M Saliba; D Saadeh; F Bouchand; A Descatha; A L Roux; B Davido; B Clair; P Denys; D Annane; C Perronne; L Bernard Journal: Spinal Cord Date: 2016-02-16 Impact factor: 2.772