사례 보고: 간질성 폐질환 치료를 위한 glucocorticoids 투여 환자에게 발생한 다제 내성 Acinetobacter baumannii 폐렴의 치료
Treatment of Multidrug-Resistant Acinetobacter baumannii Pneumonia after Glucocorticoids Administration for Interstitial Lung Disease: A Case Report
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Objective: To report a fatal case of Multidrug-resistant Acinetobacter baumannii (MDR-AB) in a patient with interstitial lung disease (ILD) on high-dose glucocorticoids. Case Summary: A 66-year-old man with a history of coniosis was transferred to the hospital with progressive cough and sputum production. This patient has been diagnosed with pneumonia and ILD on admission, requires antimicrobial therapy and systemic immunosuppressants. He received high dose of methylprednisolone and cyclophosphamide for ILD as well as ceftriaxone and azithromycin for pneumonia. On day 7 in the intensive care units (ICUs), patient had fever and leukocytosis, thus antimicrobials were switched to piperacillin. After 13 days in the ICU, Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) were isolated on transtracheal aspirate (TTA) and meropenem was initiated. However, it was revealed a multidrug-resistant Acinetobacter baumannii (MDR-AB) species, resistant to carbapenem. Patient was administered colistin but expired due to septic shock on day 84. Discussion: Systemic immunosuppressive therapy can result in infections that may compromise patient’s survival. MDR-AB has emerged as a serious cause of nosocomial infections in immunocompromised patients. MDR-AB is resistant to most standard antimicrobials and therapeutic options are limited. Conclusion: We report our recent experience with a fatal MDR-AB pneumonia in a patient with ILD, who had to be treated with high dose glucocorticoids and immunosuppressnts.
Abstract
Objective: To report a fatal case of Multidrug-resistant Acinetobacter baumannii (MDR-AB) in a patient with interstitial lung disease (ILD) on high-dose glucocorticoids. Case Summary: A 66-year-old man with a history of coniosis was transferred to the hospital with progressive cough and sputum production. This patient has been diagnosed with pneumonia and ILD on admission, requires antimicrobial therapy and systemic immunosuppressants. He received high dose of methylprednisolone and cyclophosphamide for ILD as well as ceftriaxone and azithromycin for pneumonia. On day 7 in the intensive care units (ICUs), patient had fever and leukocytosis, thus antimicrobials were switched to piperacillin. After 13 days in the ICU, Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) were isolated on transtracheal aspirate (TTA) and meropenem was initiated. However, it was revealed a multidrug-resistant Acinetobacter baumannii (MDR-AB) species, resistant to carbapenem. Patient was administered colistin but expired due to septic shock on day 84. Discussion: Systemic immunosuppressive therapy can result in infections that may compromise patient’s survival. MDR-AB has emerged as a serious cause of nosocomial infections in immunocompromised patients. MDR-AB is resistant to most standard antimicrobials and therapeutic options are limited. Conclusion: We report our recent experience with a fatal MDR-AB pneumonia in a patient with ILD, who had to be treated with high dose glucocorticoids and immunosuppressnts.
참고문헌 (23)
- Talmadge E. King, Jr, "Interstitial Lung Diseases, In Harrison’s Principles of Internal Medicine. 16th ed" (2005), McGraw-Hill
- Schwarz MI, "Approach to the evaluation and diagnosis of interstitial lung disease, In Interstitial lung disease. 4th ed" (2003), B.C.Becker
- King TE Jr, "Clinical advances in the diagnosis and therapy of the interstitial lung diseases", Am J Respir Crit Care Med, 172(3), pp.268~279 (2005)
- Bergogne-Berezin E, "Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features", Clin Microbiol Rev, 9, pp.148~165 (1996)
- Navon-Venezia SH, "Update on Pseudomonas aeruginosa and Acinetobacter baumannii infections in the healthcare setting", Curr Opin Infect Dis, 18, pp.306~313 (2005)
- Munoz-Price LS, "Acinetobacter infection", N Engl J Med, 358(12), pp.1271~1281 (2008)
- 강소욱, "입원화상환자의 특성과 항생제 사용 현황", 한국임상약학회지, 12(2), pp.55~64 (2002), 한국임상약학회
- Kim JS, "The Patterns of Infection and Therapy in Cancer Patients Receiving Chemotherapy", J Kor Soc Health-Syst Pharm, 17(4), pp.481~500 (2000)
- Herruzo R, "Two consecutive outbreaks of Acinetobacter baumannii 1-1 in a burn intensive care unit for adults", Burns, 30(5), pp.419~423 (2004)
- Zarrilli R, "Molecular epidemiology of sequential outbreaks of Acinetobacter baumannii in an intensive care unit shows the emergence of carbapenem resistance", J Clin Microbiol, 42(3), pp.946~953 (2004)
- Falagas ME, "The diversity of definitions of multidrug-resistant (MDR) and pandrugresistant (PDR) Acinetobacter baumannii and Pseudomonas aeruginosa", J Med. Microbiol, 55, pp.1619~1629 (2006)
- Jain R, "Multidrug-resistant Acinetobacter infections: an emerging challenge to clinicians", Ann Pharmacother, 38(9), pp.1449~1459 (2004)
- Michalopoulos A, "Treatment of Acinetobacter infections", Expert Opin Pharmacother, 11(5), pp.779~788 (2010)
- Wolfe F, "Treatment for rheumatoid arthritis and the risk of hospitalization for pneumonia: associations with prednisone, disease-modifying antirheumatic drugs, and anti-tumor necrosis factor therapy", Arthritis Rheum, 54(2), pp.628~634 (2006)
- Nunley DR, "Mortality associated with Acinetobacter baumannii infections experienced by lung transplant recipients", Lung, 188(5), pp.381~385 (2010)
- Bonomo RA, "Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa", Clin Infect Dis, 43(Suppl 2), pp.49~56 (2006)
- Kyungwon Lee, "Further Increases in Carbapenem-, Amikacin-, and Fluoroquinolone-Resistant Isolates of Acinetobacter spp. and P. aeruginosa in Korea: KONSAR Study 2009", Yonsei Medical Journal, 52(5), pp.793~802 (2011), 연세대학교의과대학
- Neonakis IK, "Confronting multidrug-resistant Acinetobacter baumannii: a review", Int J Antimicrob Agents, 37(2), pp.102~109 (2011)
- Reid GE, "Rapid development of Acinetobacter baumannii resistance to tigecycline", Pharmacotherapy, 27(8), pp.1198~1201 (2007)
- Michalopoulos A, "Aerosolized colistin as adjunctive treatment of ventilator-associated pneumonia due to multidrug-resistant Gram-negative bacteria: a prospective study", Respir Med, 102(3), pp.407~412 (2008)
- "Food and Drug Administration Web site: Colistimethate Information"[URL]
- Falagas ME, "Pandrugresistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii infections: characteristics and outcome in a series of 28 patients", Int J Antimicrob Agents, 32(5), pp.450~454 (2008)