In Vitro Pharmacodynamic Analyses Help Guide the Treatment of Multidrug-Resistant and Carbapenem-Resistant Bacteremia in a Liver Transplant Patient. Journal Article

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Authors: Wenzler, E; Santarossa, M; Meyer, KA; Harrington, AT; Reid, GE; Clark, NM; Albarillo, FS; Bulman, ZP
Article Title: In Vitro Pharmacodynamic Analyses Help Guide the Treatment of Multidrug-Resistant and Carbapenem-Resistant Bacteremia in a Liver Transplant Patient.
Abstract: Background: Infections due to multidrug-resistant pathogens are particularly deadly and difficult to treat in immunocompromised patients, where few data exist to guide optimal antimicrobial therapy. In the absence of adequate clinical data, in vitro pharmacokinetic (PK)/pharmacodynamic (PD) analyses can help to design treatment regimens that are bactericidal and may be clinically effective. Methods: We report a case in which in vitro pharmacodynamic analyses were utilized to guide the treatment of complex, recurrent bacteremias due to vancomycin-, daptomycin-, and linezolid-resistant and carbapenem-resistant complex in a liver transplant patient. Results: Whole-genome sequencing revealed unique underlying resistance mechanisms and explained the rapid evolution of phenotypic resistance and complicated intrahost genomic dynamics observed in vivo. Performing this comprehensive genotypic and phenotypic testing and time-kill analyses, along with knowledge of institution and patient-specific factors, allowed us to use precision medicine to design a treatment regimen that maximized PK/PD. Conclusions: This work provides a motivating example of clinicians and scientists uniting to optimize care in the era of escalating antimicrobial resistance.
Journal Title: Open forum infectious diseases
ISSN: 2328-8957; 2328-8957
Publisher: Unknown  
Date Published: 2020