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.

Synergistic Meropenem/Vaborbactam Plus Fosfomycin Treatment of KPC Producing K. pneumoniae Septic Thrombosis Unresponsive to Ceftazidime/Avibactam: From the Bench to the Bedside / Oliva, Alessandra; Curtolo, Ambrogio; Volpicelli, Lorenzo; Cogliati Dezza, Francesco; De Angelis, Massimiliano; Cairoli, Sara; Dell'Utri, Donatella; Goffredo, Bianca Maria; Raponi, Giammarco; Venditti, Mario. - In: ANTIBIOTICS. - ISSN 2079-6382. - 10:7(2021), pp. 1-8. [10.3390/antibiotics10070781]

Synergistic Meropenem/Vaborbactam Plus Fosfomycin Treatment of KPC Producing K. pneumoniae Septic Thrombosis Unresponsive to Ceftazidime/Avibactam: From the Bench to the Bedside

Oliva, Alessandra
Primo
Conceptualization
;
Curtolo, Ambrogio;Volpicelli, Lorenzo;Cogliati Dezza, Francesco;De Angelis, Massimiliano;Dell'Utri, Donatella;Raponi, Giammarco;Venditti, Mario
2021

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.
2021
fosfomycin; meropenem/vaborbactam; pharmacokinetic analyses; septic thrombosis; synergism
01 Pubblicazione su rivista::01a Articolo in rivista
Synergistic Meropenem/Vaborbactam Plus Fosfomycin Treatment of KPC Producing K. pneumoniae Septic Thrombosis Unresponsive to Ceftazidime/Avibactam: From the Bench to the Bedside / Oliva, Alessandra; Curtolo, Ambrogio; Volpicelli, Lorenzo; Cogliati Dezza, Francesco; De Angelis, Massimiliano; Cairoli, Sara; Dell'Utri, Donatella; Goffredo, Bianca Maria; Raponi, Giammarco; Venditti, Mario. - In: ANTIBIOTICS. - ISSN 2079-6382. - 10:7(2021), pp. 1-8. [10.3390/antibiotics10070781]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1563258
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