Successful treatment of extreme drug resistant Acinetobacter baumannii infection following a liver transplant

  • Muhammed Rasid Aykota Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey https://orcid.org/0000-0003-1862-6186
  • Tugba Sari Department of Infectious Diseases and Clinical Microbiology, Pamukkale University Faculty of Medicine, Denizli, Turkey
  • Sevda Yilmaz Department of General Surgery, Pamukkale University Faculty of Medicine, Denizli, Turkey https://orcid.org/0000-0002-1309-0805
Keywords: Liver transplantation, Acinetobacter baumannii, fosfomycin

Abstract

Orthotopic liver transplantation is a life-saving procedure for patients with end-stage liver failure. However, Acinetobacter baumannii infections and acute rejection are important causes of morbidity and mortality following transplants. Here we present a case report of a cadaveric donor liver transplantation with infectious complications detected after transplantation.

The patient was a 64-year-old female. Because of non-alcoholic steatohepatitis due to hepatic insufficiency (model for end-stage liver disease (MELD): 12; Child-Pugh: 9B), liver transplantation from a cadaveric donor was performed. Following the transplantation, the patient developed a blood stream infection, urinary tract infection (UTI) and postoperative wound infection from biliary leakage. A. baumannii was isolated from blood, urine and wound cultures. Imipenem (4×500 mg), tigecycline (2×50 mg) and phosphomycin (4×4 g) were administered intravenously (IV). On the 14th day of treatment, the bile fistula closed and there was no bacterial growth in blood and urine cultures. The patient was discharged with full recovery.

The duration of a transplant patient’s hospital stay, intensive care unit stay, invasive interventions, blood transfusions and immunosuppressive treatments cause an increased risk of extensively drug-resistant (XDR) A. baumannii infections, and a high mortality rate is seen despite antibiotic treatment. Phosphomycin, used in combination therapy, may be an alternative in the treatment of XDR pathogens in organ transplant patients, due to its low side effect profile and lack of interaction with immunosuppressives.

Author Biography

Tugba Sari, Department of Infectious Diseases and Clinical Microbiology, Pamukkale University Faculty of Medicine, Denizli, Turkey

Specialist, Department of Infectious Diseases and Clinical Microbiology

Published
2020-04-30
How to Cite
1.
Aykota MR, Sari T, Yilmaz S (2020) Successful treatment of extreme drug resistant Acinetobacter baumannii infection following a liver transplant. J Infect Dev Ctries 14:408-410. doi: 10.3855/jidc.11842
Section
Case Reports