Multi-target combination of antibiotics as salvage therapy for severe infection caused by pan-resistant Burkholderia cenocepacia following lung transplantation

Abstract

Burkholderia cepacia complex (Bcc) is an important group of opportunistic pathogens most frequently affecting patients with cystic fibrosis and responsible for life-threatening infections. Therapeutic options are limited owing to high levels of resistance of the organism, either intrinsic or acquired, to many antimicrobial agents. We describe here the successful treatment of a patient with cystic fibrosis who developed post-transplant lung abscesses and sternal osteitis caused by pan-resistant Burkholderia cenocepacia. He was treated with a combination of ceftazidime-avibactam, ciprofloxacin, meropenem, minocycline, sulfadiazine, and tobramycin. Repurposing multitarget drugs including old and new antibiotics, and their combinations with synergistic effects is a promising strategy to overcome clinical therapeutic impasses with difficult-to-treat-resistance (DTR) bacteria.

Keywords

• Burkholderia cenocepacia
• Pan-resistance
• Lung
• Transplantation
• Immunosuppression
• Antibiotics