From Cefepime to Colistin: Managing Multidrug-Resistant Pseudomonas aeruginosa in a Ventilator-Dependent Quadriplegic ICU Patient

TL;DR

This paper describes the treatment of a ventilator-dependent quadriplegic patient with recurring multidrug-resistant Pseudomonas aeruginosa infections.

Contribution

The paper presents a clinical case highlighting the challenges of managing multidrug-resistant P. aeruginosa in critically ill patients.

Findings

The patient experienced multiple infections requiring multiple antimicrobial regimen changes due to drug resistance.

Treatment included cefepime, aminoglycosides, meropenem, aerosolized colistin, and ceftolozane/tazobactam.

The case underscores the difficulty of treating multidrug-resistant P. aeruginosa in complex ICU patients.

Abstract

Pseudomonas aeruginosa is a Gram-negative bacterium that is commonly associated with nosocomial infections in hospitals. Due to the increasing prevalence of drug resistance, the clinical management and treatment of P. aeruginosa are becoming a significant challenge. Here, we report the case of a 21-year-old male with a history of traumatic brain injury, quadriplegia, and ventilator dependence who developed recurrent infections caused by P. aeruginosa. Over a span of nine months, the patient was diagnosed with multiple episodes of ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (UTIs) requiring intensive care hospitalizations and antimicrobial therapy. Initially, the patient was treated with cefepime and vancomycin; however, due to the rapid rise of multidrug-resistant organisms, the treatment was modified several times with aminoglycosides, meropenem, aerosolized colistin, and ceftolozane/tazobactam. The patient’s case highlights the significant challenge of multidrug-resistant P. aeruginosa and underscores the rapid progression of disease secondary to the complexity of treating infections in critically ill patients.

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