Pleşca, Antoanela Pasare and Olivia Dorneanu. Rare Case of Polymicrobial Sepsis with Cupravidus Pauculus in a Sclerodermic Patient. Biomed J Sci & Tech Res 46(3)-2022. BJSTR. MS.ID.007343.Cupriavidus pauculus (C. pauculus), formerly named Wautersia paucula, is a Gram negative, aerobic, non-fermentative germ with ubiquitous environmental distribution and can cause severe infections in humans. We present the case of a 41 -years old female patient with scleroderma with recent history of travel in Thailand, who was admitted for sepsis with Streptococcus pneumonia, associating a respiratory infection caused by multi-drug resistant germs, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. During hospitalization, respiratory status was aggravated and a non -fermentative germ, namely Cupriavidus pauculus, was identified in sputum samples. The evolution of the patient with an underlying immunocompromised condition after empiric treatment with imipenem, followed by antibiotic therapy selected by susceptibility test (levofloxacin and trimethoprim/sulfamethoxazole) was favourable with recovery after one month of hospitalization. C. pauculus is characterized by a highly variable profile of resistance, including sometimes extended -spectrum antibiotics. Only few reports of infections produced by this pathogen in humans are available. Further data are needed since C. pauculus is responsible for severe infections especially in immunosuppressed patients.
Optimizing the entire therapeutic regimen in septic critically ill patients should be based not only on improving antibiotic use but also on optimizing the entire therapeutic regimen by considering possible drug–drug or drug–nutrient interactions. The aim of this narrative review is to provide a comprehensive overview on recent advances to optimize the therapeutic regimen in septic critically ill patients based on a pharmacokinetics and pharmacodynamic approach. Studies on recent advances on TDM-guided drug therapy optimization based on PK and/or PD results were included. Studies on patients <18 years old or with classical TDM-guided therapy were excluded. New approaches in TDM-guided therapy in septic critically ill patients based on PK and/or PD parameters are presented for cefiderocol, carbapenems, combinations beta-lactams/beta-lactamase inhibitors (piperacillin/tazobactam, ceftolozane/tazobactam, ceftazidime/avibactam), plazomicin, oxazolidinones and polymyxins. Increased midazolam toxicity in combination with fluconazole, nephrotoxic synergism between furosemide and aminoglycosides, life-threatening hypoglycemia after fluoroquinolone and insulin, prolonged muscle weakness and/or paralysis after neuromuscular blocking agents and high-dose corticosteroids combinations are of interest in critically ill patients. In the real-world practice, the use of probiotics with antibiotics is common; even data about the risk and benefits of probiotics are currently spares and inconclusive. According to current legislation, probiotic use does not require safety monitoring, but there are reports of endocarditis, meningitis, peritonitis, or pneumonia associated with probiotics in critically ill patients. In addition, probiotics are associated with risk of the spread of antimicrobial resistance. The TDM-guided method ensures a true optimization of antibiotic therapy, and particular efforts should be applied globally. In addition, multidrug and drug–nutrient interactions in critically ill patients may increase the likelihood of adverse events and risk of death; therefore, the PK and PD particularities of the critically ill patient require a multidisciplinary approach in which knowledge of clinical pharmacology is essential.
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