Case report: Continuous infusions of ceftazidime-avibactam and aztreonam in combination through elastomeric infusors for 12 weeks for the treatment of bone and joint infections due to metallo-β-lactamase producing Enterobacterales

Abstract

Among carbapenem-resistant Enterobacterales, metallo-beta-lactamase producing strains represent a growing therapeutic challenge. While the association of aztreonam and ceftazidime-avibactam has been investigated in recent years for the treatment of infections involving these strains, little to no clinical data support the use of this association for the treatment of bone and joint infections. We report two cases of complex bone and joint infections involving metallo-beta-lactamase-producing Enterobacterales, successfully treated at our referral center with aztreonam and ceftazidime-avibactam for 12 weeks in continuous infusions through elastomeric infusors.

Keywords: Enterobacterales; antibiotic resistance; aztreonam; bone and joint infections; ceftazidime-avibactam; elastomeric infusor; metallo-beta-lactamase.

Figure 1

(A) An X-ray image of 2 days before debridement and implant removal surgery. (B) An X-ray image immediately after debridement and implant removal surgery. (C) An X-ray image of 6 months after surgery. (D) An X-ray image of 18 months after surgery.

Figure 2

(A) Initial presentation after 10 days of ceftobiprole for left knee cellulitis. (B) X-ray at initial presentation. (C) Thigh flap partial necrosis 10 days after implant removal surgery. (D) X-ray after implant removal surgery. (E) Second surgery: spacer replacement, rotation flap, and STSG. (F) Clinical presentation 2 months after last surgery (total knee arthroplasty reimplanted). (G) X-ray at 12 months follow-up after total knee arthroplasty reimplantation.