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Cefiderocol and Intraventricular Colistin for Ventriculitis due to an Extensively Drug-Resistant Pseudomonas Aeruginosa

João Melo e Silva
João Melo e Silva
, 
Diogo Oliveira
Diogo Oliveira
, 
João A. Louro
João A. Louro
 e 
Elisabete Monteiro
Elisabete Monteiro
   | 30 apr 2024
The Journal of Critical Care Medicine's Cover Image
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Article Category: Case Report
Pubblicato online: 30 apr 2024
Pagine: 183 - 187
Ricevuto: 01 mar 2024
Accettato: 25 apr 2024
DOI: https://doi.org/10.2478/jccm-2024-0020
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© 2024 João Melo e Silva et al., published by Sciendo
This work is licensed under the Creative Commons Attribution 4.0 International License.

Fig. 1.

Brain MRI. Axial diffusion weighted image (A), ADC map (B), T1 SE post-contrast (C), and T2*-GRE (D), demonstrating signs of ventriculitis manifested by an increase in dimensions and ‘tension’ of the walls in the occipital and temporal horns of the ventricular system [C, blue arrows]. Content with restricted diffusion and a liquid level in the occipital horns: indicating purulent content [A–B: red arrow]. There is no significant blooming in T2* suggestive of hemorrhage [D].
Brain MRI. Axial diffusion weighted image (A), ADC map (B), T1 SE post-contrast (C), and T2*-GRE (D), demonstrating signs of ventriculitis manifested by an increase in dimensions and ‘tension’ of the walls in the occipital and temporal horns of the ventricular system [C, blue arrows]. Content with restricted diffusion and a liquid level in the occipital horns: indicating purulent content [A–B: red arrow]. There is no significant blooming in T2* suggestive of hemorrhage [D].

Fig. 2.

Brain MRI. Axial diffusion weighted image (A), ADC map (B), T2/FLAIR (fluid-attenuation-inversion-recovery) (C) and T1 SE post contrast (D), showing increased signal in T2iFLAIR image at the adjacent bilateral periventricular parenchyma [C, blue arrows], with restricted diffusion [A-B] and anomalous contrast enhancement [D], exhibiting signs of loculation in the right parietal white matter [D, yellow arrow] and some focal contralateral nodules [I), red arrows].
Brain MRI. Axial diffusion weighted image (A), ADC map (B), T2/FLAIR (fluid-attenuation-inversion-recovery) (C) and T1 SE post contrast (D), showing increased signal in T2iFLAIR image at the adjacent bilateral periventricular parenchyma [C, blue arrows], with restricted diffusion [A-B] and anomalous contrast enhancement [D], exhibiting signs of loculation in the right parietal white matter [D, yellow arrow] and some focal contralateral nodules [I), red arrows].

Fig. 3.

Timeline of events, microbiological findings, and antimicrobial periods. Abbreviations: BRS- bronchial respiratory sample: CSF- cerebral spinal fluid d- days: I, intravenous: IVT- intraventricular: Nal- Magnetic resonance imaging: XDR- Extensively drug-resistant.
Timeline of events, microbiological findings, and antimicrobial periods. Abbreviations: BRS- bronchial respiratory sample: CSF- cerebral spinal fluid d- days: I, intravenous: IVT- intraventricular: Nal- Magnetic resonance imaging: XDR- Extensively drug-resistant.

Evolution of Pseudomonas Aeruginosa susceptibility testing.

Antibiogram CSF (day 25) BRS (day 25) BRS (day 48)
Piperacillin-tazobactam R R R
Amikacin - - -
Aztreonam R R R
Cefepime R R SIE
Ceftazidime R R R
Ciprofloxacin R R R
Imipenem R R R
Meropenem R R R (>32 mg/l)
Tobramycin S S S
Levofloxacin R R R
Colistin S S (1.0 mg/l) S (2.0 mg/l)
Ceftazidime-avibactam R R R (>256 mg/l)
Ceftolozane-tazobactam S S R
Imipenem-cilastin-relebactam R (6.0 mg/l) R R (4.0 mg/l)
Meropenem-varobactam - - -
eISSN:
2393-1817
Lingua:
Inglese
Frequenza di pubblicazione:
4 volte all'anno
Argomenti della rivista:
Medicine, Clinical Medicine, Internal Medicine, other, Surgery, Anaesthesiology, Emergency Medicine and Intensive-Care Medicine
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