Successful treatment of melioidosis caused by a multiresistant strain in an immunocompromised host with third generation cephalosporins

Abstract

A 32-yr-old woman with active systemic lupus erythematosus receiving prednisone and azathioprine developed lung abscesses of the right lower lobe caused by Pseudomonas pseudomallei, which was resistant concomitantly to chloramphenicol, co-trimoxazole, and tetracycline, but highly sensitive to a new cephalosporin, ceftazidime. Melioidosis was treated successfully with lobectomy and parenteral ceftazidime, which was given for 2 months without major side effects. Ceftazidime, being bactericidal, may be more promising for the eradication of P. pseudomallei, especially in immunocompromised hosts. This was also the first reported case of melioidosis in Hong Kong, where the disease might be endemic, as 4 more cases were found later.