trimethoprim--sulfamethoxazole-drug-combination and Heart-Arrest

BACKGROUND Stenotrophomonas maltophilia has the propensity to cause a plethora of opportunistic infections in humans owing to biofilm formation and antibiotic resistance. It is often seen as a co-organism along with Pseudomonas aeruginosa. CASE REPORT A 70-year-old woman with several co-morbidities presented reporting hypoglycemia and dyspnea. An imaging study of the chest was suggestive of deterioration of pneumonia, with increased opacities. Initial respiratory cultures were negative, while subsequent repeat cultures revealed the growth of Stenotrophomonas maltophilia susceptible to trimethoprim plus sulfamethoxazole and levofloxacin. The patient had a poor prognosis and eventually died despite appropriate measures. CONCLUSIONS A decline in the clinical status of a patient such as ours makes it hard to quickly diagnose this organism correctly. Physicians should thus be cautious of Stenotrophomonas maltophilia-induced infection and more emphasis should be placed on appropriate treatment due to the emerging risk of antibiotic resistance.

Topics: Aged; Anti-Bacterial Agents; Fatal Outcome; Female; Gram-Negative Bacterial Infections; Heart Arrest; Humans; Levofloxacin; Opportunistic Infections; Pneumonia; Sepsis; Stenotrophomonas maltophilia; Trimethoprim, Sulfamethoxazole Drug Combination

Torsades de pointes (TdP) is a rapid, polymorphic and usually self-terminating ventricular tachycardia associated with the long QT syndrome. Many drugs may cause prolongation of QT interval and be the trigger for TdP occurrence. We present the case of 52-year-old male who was treated with clarithromycin due to bilateral atypical pneumonia. However, on the fourth day of hospitalization he deteriorated, developed pulmonary edema and short cardiac arrest. After successful resuscitation, unfortunately amiodarone and co-trimoxazole were given causing the arrhythmic storm which required many defibrillations. The case highlights the importance of careful QT measurement, appropriate TdP treatment and difficulties resulting from the patient's disagreement for invasive treatment. We think, that knowledge of drug-induced long QT syndrome and its consequences should be widely spread not only in cardiologists, but also in others doctors.

Topics: Amiodarone; Anti-Arrhythmia Agents; Clarithromycin; Drug Therapy, Combination; Electrocardiography; Heart Arrest; Humans; Long QT Syndrome; Male; Middle Aged; Pneumonia; Pulmonary Edema; Torsades de Pointes; Trimethoprim, Sulfamethoxazole Drug Combination

Topics: Drug Hypersensitivity; Fever; Heart Arrest; HIV Infections; Humans; Hypotension; Infant; Male; Respiratory Insufficiency; Tachycardia; Trimethoprim, Sulfamethoxazole Drug Combination