Siran KESKE, Tümer GÜVEN, Gül Ruhsar YILMAZ, Mehmet Akın TAŞYARAN, Rahmet GÜNER

A health care-associated pneumonia case due to colistin resistant Acinetobacter baumannii

Yetmiş sekiz yaşındaki erkek hasta ensefalopati tanısı ile nöroloji bölümüne yatırıldı. Ventilatör ilişkili pnömoni (VİP) nedeniyle başlanan imipenem tedavisinin 13. gününde fizik muayene, laboratuar ve radyolojik bulgulara dayanarak yeni bir VİP tanısı kondu. Ampirik olarak sefoperazon sulbaktam 2 x 2 gr/gün IV tedavisi başlandı. Tedavinin 3. gününde endotrakeal aspirat kültüründe hem Vitek hem de e-testle sefoperazon-sulbaktam (orta duyarlı) ve tigesiklin (MIC: 4 mg/L, orta duyarlı) hariç diğer tüm antibiyotiklere (kolistin dahil) dirençli Acinetobacter baumannii üremesi oldu. Sefoperazon-sulbaktam 2 x 2 gr/gün IV tedavisine tigesiklin 2 x 50 mg/gün (100 mg yükleme dozunu takiben) IV, kolistin 2 x 150 mg/gün IV ve kolistin 2 x 75 mg/gün inhaler eklendi. Bu kombinasyon tedavisi altında hastada klinik yanıt alındı ve tedavi 14 güne tamamlandı. Hasta 3 ay sonra nörolojik sekel ile hastaneden taburcu edildi. Bu olgu kolistin dirençli Acinetobacter baumannii olgularının ülkemiz için bir sorun haline gelmeye başladığını göstermek amacıyla sunulmaktadır

Kolistin dirençli Acinetobacter baumannii’ye bağlı sağlık bakımı ile ilişkili bir pnömoni vakası

A 78 year old male was hospitalized in neurology clinic with a diagnosis of encephalopathy. On 13th day of imipenem treatment for ventilator-associated pneumonia (VAP), a new VAP episode was diagnosed based on physical examination, laboratory and radiological findings. Cefoperazone-sulbactam 2x2 gr/day IV was started empirically. In the 3rd day of treatment Acinetobacter baumannii was identified from endotracheal aspirate culture that was resistant to all other antibiotics including colistin except cefoperazone-sulbactam (intermediate) and tigecycline (MIC: 4 mg/L, intermediate) by VITEK and E-test. Tigecycline 2 x 50 mg (after loading dose of 100 mg) IV, colistin IV 2 x 150 mg and colistin inhaler 2 x 75 mg were added to the cefoperazone-sulbactam 2 x 2 gr IV. Clinical findings were improved under this combination and completed to 14 days. The patient was discharged from hospital with neurological sequel after three months. This case has been presented to emphasize that colistin resistant Acinetobacter baumannii is becoming a problem for our country. J Microbiol Infect Dis 2014; 4(3): 111-113

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