read the transcript - Antibiotic Awareness

Antibiotic Awareness Week, November 2011Rita Finley, Lynora Saxinger, Daniel ThirionTranscription: Marjolaine Hébertshould be raising red flags with people who are familiar with thistype of therapy. He required a decortication because of an Empyema,he had to have a surgical clean-out of his chest, and he remainedcolonized with this bug. And when it was first isolated, it wassensitive to Aztreonam, and intermediate to Ceftazidime, andsensitive to Colistin, but resistant to all Aminoglycocides,Carbopanems, and Pip Tazo. And then after he was exposed toCeftazidime for four days, just towards the end ofSeptember/beginning of October, we actually induced Aztreonam ofCeftazidime resistance, leaving it susceptible only to a single agent,Colistin, which we are unfortunately having to use more of these daysfor multi-resistant bugs.Another case is a 38 year old man with leukemia who is recentlydischarged from the ward after induction chemotherapy. He wasdoing very well. He was afebrile but he was still neutropenic and sohe was put on oral Cipro and Clavulin as an outpatient. He returnedto the hospital with very severe sepsis requiring massive support,and they started him on Vanco, Pip Tazo, and Tobramycin. We wereasked to see him when his blood cultures became gram negativebacilli, and we actually changed him to Imepenam because we wereconcerned that this arose while he was on Clavulin and Cipro. Andthe susceptibility results, which came back after he died, showed thathis isolate was really susceptible only to Colistin. He had septic shockin spite of maximal support, and after an intra-cerebral bleed relatedto his abscess, care was withdrawn. And so this 38 year old man diedof a multi-resistant Pseudomonas.And a third case from the same week – a 90 year old man who camein with vomiting with tube feeds. Quite unwell, but systematicallystable. And his daughter is his main caregiver and very devoted. Hisurine analysis showed more than 50 White Cells. He was sent homeon oral Cefixime from the Emergency Room. The blood culturesbecame positive for gram negative bacilli. The patient’s family wascalled, they came in and they started outpatient Ceftriaxone becauseapparently, he looked quite well. The patient was actually receivingthe Ceftriaxione when the following result was received. He had an E.coli isolate that was susceptible only to Carbopenems, Colistin, andPUBLIC HEALTH AGENCY of CANADA//AGENCE DE LA SANTÉ PUBLIQUE du CANADA 18