piperacillin--tazobactam-drug-combination and Endocarditis

Roseomonas mucosa, as a Gram-negative coccobacilli, is an opportunistic pathogen that has rarely been reported in human infections. Here we describe a case of bacteremia in an infective endocarditis patient with systemic lupus erythematosus (SLE).. A 44-year-old female patient with SLE suffered bacteremia caused by Roseomonas mucosa complicated with infective endocarditis (IE). The patient started on treatment with piperacillin-tazobactam and levofloxacin against Roseomonas mucosa, which was switched after 4 days to meropenem and amikacin for an additional 2 weeks. She had a favorable outcome with a 6-week course of intravenous antibiotic therapy.. Roseomonas mucosa is rarely reported in IE patients; therefore, we report the case in order to improve our ability to identify this pathogen and expand the range of known bacterial causes of infective endocarditis.

Topics: Adult; Amikacin; Anti-Bacterial Agents; Bacteremia; Endocarditis; Endocarditis, Bacterial; Female; Gram-Negative Bacterial Infections; Humans; Levofloxacin; Lupus Erythematosus, Systemic; Methylobacteriaceae; Piperacillin, Tazobactam Drug Combination

The first cases of infective endocarditis due to a new species of Bergeyella, Bergeyella cardium sp. nov., are reported. Two strains, 13-07(T) (= JCM 30115(T) = NCCP 15908(T)) and 13-16, were independently isolated from 2 patients in different hospitals in Korea. Initially, the isolates were identified as Brevundimonas spp.; however, their 16S rRNA gene sequences shared a similarity of 94.9% with Bergeyella zoohelcum, implying that they are a new species belonging to of the genus Bergeyella. The organisms might be susceptible to many commonly used antibiotics, including penicillin. The first case was successfully treated with ceftriaxone, and the second, with piperacillin/tazobactam plus amikacin.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Cluster Analysis; DNA, Bacterial; DNA, Ribosomal; Endocarditis; Flavobacteriaceae; Hospitals; Humans; Korea; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Sequence Data; Penicillanic Acid; Phylogeny; Piperacillin; Piperacillin, Tazobactam Drug Combination; RNA, Ribosomal, 16S; Sequence Analysis, DNA; Treatment Outcome

We sought to describe a case of pharmacodynamically-optimized dosing of piperacillin-tazobactam in a patient that cleared their infections after treatment with high-dose, extended-infusion piperacillin-tazobactam and summarize the literature on the benefits of extended-infusion of beta-lactams.. At an outside hospital, a 78 year-old male presented with fevers and shortness of breath. He was empirically initiated on standard doses of vancomycin and piperacillin-tazobactam for suspected pneumonia and sepsis. Blood and sputum cultures identified Elizabethkingia meningosepticum sensitive only to piperacillin-tazobactam by E-test susceptibility testing. After 10 days of empiric therapy with piperacillin-tazobactam dosed at 3.375 g IV every 8 h over 30 min, the patient transferred to our institution and was initiated on piperacillin-tazobactam at 3.375 g IV every 8 h administered as a 4 h infusion. The patient failed to improve; piperacillin-tazobactam was changed to 4.5 g IV over 4 h every 8 h and later changed to the hospital protocol dose of 3.375 g IV over 4 h every 6 h. The patient achieved negative blood cultures within 24 h of optimized dosing.. We present the first case to our knowledge that describes failure to respond and subsequent response within a single patient where beta-lactam dosing was altered to optimize pharmacokinetics and pharmacodynamics (PK-PD). Our patient received non-standard dose-escalation for piperacillin-tazobactam. Drug exposure was estimated post-hoc utilizing robust mathematical simulations to describe alterations in disposition over time. This case demonstrates that extended-infusion administration of beta-lactams may provide improved microbiological activity.

Topics: Aged; Anti-Bacterial Agents; Bacteremia; beta-Lactamases; beta-Lactams; Endocarditis; Gram-Negative Bacterial Infections; Humans; Infusions, Intravenous; Male; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination