Combining bacteriophages with cefiderocol and meropenem/vaborbactam to treat a pan‐drug resistant Achromobacter species infection in a pediatric cystic fibrosis patient

• Published in: Pediatric pulmonology Vol. 55; no. 11; pp. 2990 - 2994
• Main Authors: Gainey, Andrew B., Burch, Anna‐Kathryn, Brownstein, Michael J., Brown, David E., Fackler, Joseph, Horne, Bri'Anna, Biswas, Biswajit, Bivens, Brittany N., Malagon, Francisco, Daniels, Robert
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.11.2020
• Subjects: Achromobacter; Anti-Bacterial Agents - administration & dosage; Antibiotics; bacteriophage; Bacteriophages; Boronic Acids - administration & dosage; Cefiderocol; Cephalosporins - administration & dosage; Child; Combined Modality Therapy; Cystic fibrosis; Cystic Fibrosis - drug therapy; Drug Combinations; Drug resistance; Drug Resistance, Bacterial; Drug Resistance, Multiple; Female; Gram-Negative Bacterial Infections - drug therapy; Heterocyclic Compounds, 1-Ring - administration & dosage; Humans; meropenem; Meropenem - administration & dosage; Pediatrics; Phages; cefiderocol; meropenem; bacteriophage; cystic fibrosis; achromobacter
• ISSN: 8755-6863; 1099-0496; 1099-0496
• DOI: 10.1002/ppul.24945

Cystic fibrosis is associated with significant morbidity and early mortality due to recurrent acute and chronic lung infections. The chronic use of multiple antibiotics without pathogen eradication increases the possibility of extensive drug resistance or even pan‐drug resistance (PDR). It is imperative that new or alternative treatment options be explored. We present a clinical case of a 10‐year‐old female cystic fibrosis patient, infected with a PDR Achromobacter spp. She was treated with cefiderocol, meropenem/vaborbactam, and bacteriophage therapy (Ax2CJ45ϕ2) during two separate admissions in an attempt to clear her infection and restore baseline pulmonary function. The Centers for Disease Control and Prevention confirmed antibiotic susceptibilities, which showed resistance to both cefiderocol and meropenem/vaborbactam. However, after using all three agents concomitantly during the second treatment course, our patient's pulmonary function improved dramatically, and the Achromobacter spp. could not be isolated from sputum samples obtained 8 and 16 weeks after completion of therapy. Overall, the treatment regimen consisting of cefiderocol, meropenem/vaborbactam, and bacteriophage was safe and well‐tolerated in our patient.