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Oliva A, Curtolo A, Volpicelli L, Cogliati Dezza F, De Angelis M, Cairoli S, Dell’Utri D, Goffredo BM, Raponi G, Venditti M. Synergistic Meropenem/Vaborbactam Plus Fosfomycin Treatment of KPC Producing K. pneumoniae Septic Thrombosis Unresponsive to Ceftazidime/Avibactam: From the Bench to the Bedside. Antibiotics (Basel) 2021; 10:antibiotics10070781. [PMID: 34199072 PMCID: PMC8300652 DOI: 10.3390/antibiotics10070781] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 06/24/2021] [Accepted: 06/25/2021] [Indexed: 12/29/2022] Open
Abstract
Gram-negative bacilli septic thrombosis (GNB-ST) represents a subtle and often misleading condition, potentially fatal if not recognized early and requiring prolonged antimicrobial therapy and anticoagulation. Herein, reported for the first time, is a very challenging case of Klebsiella producing carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) ST unresponsive to ceftazidime/avibactam (CZA) relapsed first with meropenem/vaborbactam (MVB) monotherapy and subsequently cured with MVB plus fosfomycin (FOS) combination. The present case highlights the possibility of CZA underexposure on the infected thrombus and the risk of in vivo emergence of CZA resistance in the setting of persistent bacteremia and sub-optimal anticoagulation. Pharmacokinetic analyses showed that both MVB and FOS were in the therapeutic range. In vitro studies demonstrated a high level of MVB + FOS synergism that possibly allowed definitive resolution of the endovascular infection.
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Affiliation(s)
- Alessandra Oliva
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.O.); (A.C.); (L.V.); (F.C.D.); (M.D.A.); (G.R.)
| | - Ambrogio Curtolo
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.O.); (A.C.); (L.V.); (F.C.D.); (M.D.A.); (G.R.)
| | - Lorenzo Volpicelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.O.); (A.C.); (L.V.); (F.C.D.); (M.D.A.); (G.R.)
| | - Francesco Cogliati Dezza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.O.); (A.C.); (L.V.); (F.C.D.); (M.D.A.); (G.R.)
| | - Massimiliano De Angelis
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.O.); (A.C.); (L.V.); (F.C.D.); (M.D.A.); (G.R.)
| | - Sara Cairoli
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (S.C.); (B.M.G.)
| | - Donatella Dell’Utri
- Department of Anesthesia and Critical Care Medicine, Policlinico Umberto I, 00161 Rome, Italy;
| | - Bianca Maria Goffredo
- Biochemistry Laboratory, Department of Specialist Pediatrics, Bambino Gesù Children’s Hospital, 00165 Rome, Italy; (S.C.); (B.M.G.)
| | - Giammarco Raponi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.O.); (A.C.); (L.V.); (F.C.D.); (M.D.A.); (G.R.)
| | - Mario Venditti
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (A.O.); (A.C.); (L.V.); (F.C.D.); (M.D.A.); (G.R.)
- Correspondence:
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Mondèjar EF, Mata GV, Ferròn F, Navarrete P, Ruiz JMT, Lestavel P, Tronchon L, Chambrin MC, Mangalaboyi J, Rime A, Chopin C, Valta P, Campodonico R, Corbeil C, Chassè M, Châtillon A, Braidy J, Matar N, Milic-Emili J, Lòpez-Messa J, Penas L, Valverde A, Dambrosio M, Roupie E, Carneiro A, Anglade MC, Vasile N, Brochard L, Lemaire F, Rubio J, Carrasco MS, Mateo I, Sierra R, Escolar A, Cozar J, Bastin K, Knapen R, Moraine JJ, Melot C, Sergysels R, Kahn RJ, Pelosi P, Cereda M, Foti G, D’Andrea L, Manetti B, Lissoni A, Pesenti A, Gallego JMA, Rubi JAG, Sànchez CP, Moreno AM, Lherm T, Boiteau R, Valente E, Beaussier M, Chamieh F, Tenaillon A, Righini ER, Alvisi R, Ragazzi R, Volta CA, Capuzzo M, Gritti G, Sydow M, Burchardi H, Zinserling J, Crozier TA, Guttmann J, Eberhard L, Bertschmann W, Fabry B, Wolff G, Rubini A, DelMonte DD, Catena V, Attar I, Rattazzi G, Alati GL, Diaz MA, Mata GV, Navarro PN, Lòpez FG, Morales AM, Isenegger J, Picazo L, Sanchez A, Hernandez B, Pons A, Conti G, Di Chiara L, De Blasi RA, Dell’Utri D, Cogliati A, Pelaia P, Ferretti A, Bernasconi F, Banfi G, Pesenti A, Putensen C, Putensen-Himmer G, Leon M, Huygen PEM, Gültuna I, Zwart A, Ince C, Bruining HA, Pompe JC, Kesecioĝlu J, Rabbat A, Laaban JP, Orvoen-Frija E, Achkar A, Rochemaure J, Frigo V, Solca M, Melloni G, Gerbsa C, Ornaghi A, Mancini S, Cavagnoli R, Fasano W, Santos C, Roca J, Torres A, Cardùs J, Barberà JA, Felez MA, Rodriguez-Roisin R, Oviedo-Moreira R, Beydon L, Nakos G, Precates A, Mathas C, Bassilakis N, Chagianagnostou K, Massoura L, Labropoulos S, Devroey M, Vansnick P, Mèlot C, Naeije R, Nagy V, Kiiski R, Kaitainen S, Karppi R, Takala J, Kesecioglu J, Erdmann W, Marin J, Arnau A, Tejeda M, Olivares D, Servera E, Boix JH, Alvarez F, Peydro F, Mira JP, Belghith M, Renaud B, Deland E, Brunet F, Brusset A, Lanore JJ, Hamy I, Termignon JL, Soubrane O, Pochard F, Dhainaut JF, Sidhu PS, Cockburn JF, Nicholson DA, Kennedy A, Dawson P, Servera FE. Acute/Chronic respiratory failure III. Intensive Care Med 1992. [DOI: 10.1007/bf03216369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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