Description of an effective treatment regimen for ventilator-associated pneumonia due to pandrug-resistant Providencia: a case report

Abstract

Because of an increased prevalence of infections with resistant Gram-negative bacteria, finding optimal treatment regimens for these cases is one of the major healthcare concerns. Providencia is a Gram-negative bacteria belonging to the Enterobacteriaceae family. This article aims to describe an effective antibacterial regimen used for treating ventilator-associated pneumonia (VAP) with species of Providencia that are resistant to all antimicrobial classes. We present the case of a 74-year-old woman suffering from VAP caused by pandrug-resistant Providencia. The patient received high-dose intravenous meropenem (1 g every 12 h, infused over 4 h), intravenous amikacin (1,500 mg every 48 h) and nebulised amikacin (250 mg every 6 h). The dosages were calculated based on weight and renal function (GFR = 13.69 ml/min/1.73). After 23 days of treatment, following improvement in clinical signs (including fever), a drop in leucocytes counts, a higher than 80% reduction in procalcitonin levels (0.12), together with confirmed microbial eradication (negative sputum cultures), the antibacterial regimen was discontinued. In conclusion, when dealing with an infection with a pan-resistant microorganism, using combinations of antibiotics in high doses can be an option. These treatment regimens have the potential of overcoming in vitro resistance, leading to clinical improvement and microbial eradication.

Providencia Species – Involvement in Pathology and Multidrug Resistance in a Romanian County Hospital

“…Providencia spp. are involved in ventilatorassociated pneumonia making therapy very difficult due to pandrug resistance [14]. amikacin, ciprofloxacin, trimethoprim-sulfa-metoxazole, aztreonam and resistant to the aminopenicillins, firstgeneration cephalo-sporins, gentamicin, tobramycin.…”

“…In case of pandrug resistant Providencia strains in vitro, use of a high dose antibiotic combinations (eg meropenem 1 g every 12 hours, intravenous amikacin 1.5 mg every 48 hours and nebulised amikacin 250 mg every 6 hours) could be an option because, according to published studies or cases, it could lead to clinical improvement and bacterial eradication. [1], [14].…”