A 30-year-old bombing victim with a fracture-related pandrug-resistant Klebsiella pneumoniae infection after long-term (>700 days) antibiotic therapy is treated with a pre-adapted bacteriophage along with meropenem and colistin, followed by ceftazidime/avibactam. This salvage therapy results in objective clinical, microbiological and radiological improvement of the patient’s wounds and overall condition. In support, the bacteriophage and antibiotic combination is highly effective against the patient’s K. pneumoniae strain in vitro, in 7-day mature biofilms and in suspensions.
Certain patients who recover from severe pneumonia due to coronavirus disease 2019 (COVID-19) remain symptomatic in the post-infectious period, either clinically, radiologically, or respiratory. The post-COVID-19 period is characterized by clinical symptoms of varying duration from one subject to another and does not seem to depend on the severity of initial pneumonia. The persisting inflammatory and/or immune reactions in the post-COVID-19 period may play a role in the development of pulmonary lesions. Here, we report the case of a 61-year-old man with severe COVID-19 pneumonia, complicated by acute respiratory distress syndrome and pulmonary embolism, which required the patient's admission to the intensive care unit and high-flow oxygen therapy. The patient was hospitalized for 23 days for the management of his severe COVID-19 pneumonia. Afterwards, he was discharged home following a negative SARS-CoV-2 PCR test. The post-COVID-19 period was characterized by a complex respiratory symptomatology associating cough, resting dyspnea, and exertional dyspnea requiring oxygen therapy for several weeks. Surprisingly, the follow-up chest CT scan performed 4 weeks after discharge revealed bilateral interstitial lung lesions. After ruling out pulmonary superinfection, the patient was treated with oral corticosteroid for 3 months at a digressive dose. In our case, the use of corticosteroid therapy in the post-COVID19 phase had improved the outcome of the lung disease. These benefits are characterized by a rapid symptomatic improvement, accelerated repair of pulmonary images, rapid oxygen withdrawal, and rapid return to daily activities.
Tras recuperarse de una neumonía grave debida a la enfermedad por coronavirus 2019 (COVID-19), algunos pacientes permanecen sintomáticos en el periodo posinfeccioso, ya sea de manera clínica, radiológica o respiratoria. El periodo post-COVID-19 se caracteriza por síntomas clínicos cuya duración varía de un sujeto a otro y no parece depender de la gravedad de la neumonía inicial. Las reacciones inflamatorias o inmunitarias persistentes en el periodo post-COVID-19 pueden desempeñar un papel en el desarrollo de las lesiones pulmonares. Aquí reportamos el caso de un hombre de 61 años con neumonía grave por COVID-19, complicada con síndrome de dificultad respiratoria aguda y embolia pulmonar, que requirió ingresar a la unidad de cuidados intensivos y oxigenoterapia de alto flujo. El paciente permaneció hospitalizado durante 23 días para tratar la neumonía grave por COVID-19. Posteriormente, se le envió a casa tras una prueba negativa de PCR para el SARS-CoV-2. El periodo posterior al COVID-19 se caracterizó por una sintomatología respiratoria compleja, con tos, disnea en reposo y disnea de esfuerzo que requirió oxigenoterapia durante varias semanas. Sorprendentemente, la tomografía computarizada torácica de seguimiento realizada cuatro semanas después del alta reveló lesiones pulmonares intersticiales bilaterales. Tras descartar una sobreinfección pulmonar, el paciente recibió tratamiento con corticosteroides orales durante tres meses en dosis digresiva. En nuestro caso, el uso de corticosteroides en la fase posterior al COVID-19 mejoró la enfermedad pulmonar. Estos beneficios se caracterizan por una rápida mejoría sintomática, la reparación acelerada de las imágenes pulmonares, la rápida retirada de oxígeno y un pronto retorno a las actividades cotidianas.
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