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Treatment of endocarditis due to Pseudomonas aeruginosa with imipenem
1Division of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut.
Abstract:
Therapy for endocarditis due to Pseudomonas aeruginosa is complicated by the emergence of resistance during therapy, lack of universally available synergistic antimicrobial agents, and unacceptably high morbidity and mortality rates. The authors report a case of aortic valve endocarditis due to P. aeruginosa in which resistance to piperacillin developed during combined therapy with tobramycin. Bacteriologic cure was obtained with a combination of imipenem/cilastatin and tobramycin. The authors review six other cases of P. aeruginosa endovascular infections treated with imipenem.
Insights
Pseudomonas aeruginosa endocarditis treatment is challenging due to emerging resistance. A novel combination therapy of imipenem/cilastatin and tobramycin achieved bacteriologic cure in a difficult aortic valve endocarditis case.
Area of Science:
- Infectious Diseases
- Cardiology
- Antimicrobial Resistance
Background:
- Pseudomonas aeruginosa endocarditis presents significant therapeutic challenges, including antimicrobial resistance, limited synergistic options, and high mortality.
- Standard treatments often fail due to rapid development of resistance during therapy.
Observation:
- A case of aortic valve endocarditis caused by P. aeruginosa is presented.
- The patient developed resistance to piperacillin while on combined therapy with tobramycin.
Findings:
- Bacteriologic cure was achieved using a combination of imipenem/cilastatin and tobramycin.
- A review of six additional cases of P. aeruginosa endovascular infections treated with imipenem supports these findings.
Implications:
- Imipenem/cilastatin combined with tobramycin offers a potential therapeutic strategy for resistant P. aeruginosa endocarditis.
- This approach may improve outcomes in challenging endocarditis cases.
- Further research into effective treatments for resistant Gram-negative bacterial endocarditis is warranted.