# 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.

## Key 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.