A patient presenting with cholangitis due to Stenotrophomonas maltophilia and Pseudomonas aeruginosa successfully treated with intrabiliary colistine

  • Pablo N. Pérez | dr_pablo_p_g@hotmail.com Department of Internal Medicine, Hospital Ángeles Clínica Londres, Mexico City, Mexico.
  • María A. Ramírez Department of Epidemiology, Instituto Nacional de Neurología y Neurocirugía, Mexico City, Mexico.
  • José A. Fernández Department of Internal Medicine, Hospital Ángeles Clínica Londres, Mexico City, Mexico.
  • Laura Ladrón de Guevara Department of Gastroenterology and Hepatology, Centro Médico Nacional 20 de Noviembre, Mexico City, Mexico.

Abstract

Anatomical barriers for antibiotic penetration can pose a particular challenge in the clinical setting. Stenotrophomonas maltophilia (SM) and Pseudomonas aeruginosa (PA) are two pathogens capable of developing multiple drug-resistance (MDR) mechanisms. We report the case of a 56-year-old female patient with a permanent percutaneous transhepatic biliary drainage (PTBD), who was admitted to our hospital with a cholangitis due to a MDR Escherichia coli strain. Upon admission, culture-guided antimicrobial therapy was conducted and the biliary catheter was replaced, with poor clinical response. Subsequently, SM and PA were detected. Treatment with fosfomycin and colistine was initiated, again without adequate response. Systemic colistine and tigecycline along with an intrabiliary infusion of colistine for 5 days was then used, followed by parenteral fosfomycin and tigecycline for 7 days. The patient was then successfully discharged. This is the first case report we are aware of on the use of intrabiliary colistine. It describes a new approach to treating cholangitis by MDR bacteria in patients with a PTBD.

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Published
2014-05-13
Info
Issue
Section
Case Reports
Keywords:
cholangitis, colistine, Pseudomonas, Stenotrophomonas
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How to Cite
Pérez, P., Ramírez, M., Fernández, J., & Ladrón de Guevara, L. (2014). A patient presenting with cholangitis due to Stenotrophomonas maltophilia and Pseudomonas aeruginosa successfully treated with intrabiliary colistine. Infectious Disease Reports, 6(2). https://doi.org/10.4081/idr.2014.5147