Combining bacteriophages with cefiderocol and meropenem/vaborbactam to treat a pan‐drug resistant Achromobacter species infection in a pediatric cystic fibrosis patient

Cystic fibrosis is associated with significant morbidity and early mortality due to recurrent acute and chronic lung infections. The chronic use of multiple antibiotics without pathogen eradication increases the possibility of extensive drug resistance or even pan‐drug resistance (PDR). It is impera...

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Published in:Pediatric pulmonology 2020-11, Vol.55 (11), p.2990-2994
Main Authors: Gainey, Andrew B., Burch, Anna‐Kathryn, Brownstein, Michael J., Brown, David E., Fackler, Joseph, Horne, Bri'Anna, Biswas, Biswajit, Bivens, Brittany N., Malagon, Francisco, Daniels, Robert
Format: Article
Language:English
Subjects:
Achromobacter
Anti-Bacterial Agents - administration & dosage
Antibiotics
bacteriophage
Bacteriophages
Boronic Acids - administration & dosage
Cefiderocol
Cephalosporins - administration & dosage
Child
Combined Modality Therapy
Cystic fibrosis
Cystic Fibrosis - drug therapy
Drug Combinations
Drug resistance
Drug Resistance, Bacterial
Drug Resistance, Multiple
Female
Gram-Negative Bacterial Infections - drug therapy
Heterocyclic Compounds, 1-Ring - administration & dosage
Humans
meropenem
Meropenem - administration & dosage
Pediatrics
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Summary:Cystic fibrosis is associated with significant morbidity and early mortality due to recurrent acute and chronic lung infections. The chronic use of multiple antibiotics without pathogen eradication increases the possibility of extensive drug resistance or even pan‐drug resistance (PDR). It is imperative that new or alternative treatment options be explored. We present a clinical case of a 10‐year‐old female cystic fibrosis patient, infected with a PDR Achromobacter spp. She was treated with cefiderocol, meropenem/vaborbactam, and bacteriophage therapy (Ax2CJ45ϕ2) during two separate admissions in an attempt to clear her infection and restore baseline pulmonary function. The Centers for Disease Control and Prevention confirmed antibiotic susceptibilities, which showed resistance to both cefiderocol and meropenem/vaborbactam. However, after using all three agents concomitantly during the second treatment course, our patient's pulmonary function improved dramatically, and the Achromobacter spp. could not be isolated from sputum samples obtained 8 and 16 weeks after completion of therapy. Overall, the treatment regimen consisting of cefiderocol, meropenem/vaborbactam, and bacteriophage was safe and well‐tolerated in our patient.
ISSN:8755-6863
1099-0496
DOI:10.1002/ppul.24945