Carbapenem-Resistant Pseudomonas aeruginosa Spondylodiscitis Treated with Ceftazidime-Avibactam: A Case Report with Literature Review

Guilherme José da Nóbrega Danda,1 Andreia Craveiro Franco,1 Elisangela Ana Paula Gomes,2 Vinícius Vianna Abreu Montanaro,3 Bernardo José Alves Ferreira Martins,4 Vitor Viana Bonan de Aguiar5 1Department of Internal Medicine, SARAH Network of Rehabilitation Hospitals, Brasília, Federal District, Brazil; 2Department of Microbiology, SARAH Network of Rehabilitation Hospitals, Brasília, Federal District, Brazil; 3Department of Neurology, SARAH Network of Rehabilitation Hospitals, Brasília, Federal District, Brazil; 4Department of Radiology, SARAH Network of Rehabilitation Hospitals, Brasília, Federal District, Brazil; 5Department of Neurosurgery, SARAH Network of Rehabilitation Hospitals, Brasília, Federal District, BrazilCorrespondence: Guilherme José da Nóbrega Danda, Hospital Sarah Brasília, SMHS 501 Bloco A, Brasília, DF, 70335-901, Brazil, Tel +55613199-1111, Email guilhermedanda@yahoo.com.brAbstract: Pyogenic spondylodiscitis (PS) is a highly morbid and potentially fatal bacterial infection with an increasing incidence in recent decades. Its diagnosis and treatment are challenging, especially with the expansion of multidrug- or extensively drug-resistant bacteria. We report a rare case of PS caused by carbapenem-resistant Pseudomonas aeruginosa (CRPA) that was treated with ceftazidime-avibactam (C/A). The choice of C/A therapy was based on the patient’s bacterial sensitivity profile and intolerance to the initial therapeutic regimen (polymyxin B and meropenem). The total antimicrobial treatment time was seven weeks. The evolution of the clinical course met the cure criteria, which was characterized by remission of signs and symptoms, normalization of inflammatory markers, and radiological improvement over 18 months of clinical follow-up. This is a rare case of CRPA spondylodiscitis that responded to C/A treatment.Keywords: antibiotic, β-lactam/β-lactamase inhibitor, resistance, vertebral osteomyelitis, bone and joint infection