{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T05:32:56Z","timestamp":1678339976729},"reference-count":8,"publisher":"Georg Thieme Verlag KG","issue":"04","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Dtsch Med Wochenschr"],"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:title>Zusammenfassung<\/jats:title><jats:p>\n          Anamnese\u2002Die Vorstellung der 68-j\u00e4hrigen Patientin erfolgte bei hohem Fieber, allgemeinem Unwohlseisn und k\u00f6rperlicher Schw\u00e4che in der Neutropenie bei Rezidiv einer akuten myeloischen Leuk\u00e4mie nach allogener Stammzelltransplantation.<\/jats:p><jats:p>\n          Verlauf\/Diagnose\u2002Aufgrund der bestehenden Immundefizienz wurde eine kalkulierte antibiotische Therapie mit Piperacillin\/Tazobactam begonnen. Bei positivem 4MRGN-Screening wurde diese kalkuliert auf Colistin und Ceftazidim\/Avibactam umgestellt. Diagnostiziert wurde ein Zungenulkus mit Abszessbildung und phlegmon\u00f6ser Weichteilreaktion. In mehreren mikrobiologischen Proben, inklusive einer Blutkultur, gelang der Nachweis eines Klebsiella-pneumoniae-Komplexes \u2013 4MRGN mit molekularbiologischem Nachweis einer Metallo-Beta-Laktamase vom Typ VIM-1 (Verona-Integron-Metallo-Beta-Laktamase-1). Ein dauerhafter R\u00fcckgang der klinischen und laborchemischen Infektparameter konnte erst nach antibiogrammgerechter Umstellung der Therapie auf das k\u00fcrzlich zugelassene Siderophor-Cephalosporin Cefiderocol erreicht werden. Zur Fokus-Sanierung erfolgte eine Abszessspaltung. Nach insgesamt 18 Tagen konnte die antibiotische Therapie erfolgreich beendet werden. Zwei Tage sp\u00e4ter wurde die Patientin in stabilem Allgemeinzustand in ihr h\u00e4usliches Umfeld entlassen.<\/jats:p><jats:p>\n          Folgerung\u2002Vierfach multiresistente gramnegative Bakterien (4MRGN) sind aufgrund ihrer Resistenz gegen\u00fcber 4 bakterizid wirkenden Hauptantibiotikagruppen (Acylureidopenicilline, Cephalosporine der 3. Generation, Carbapeneme, Fluorchinolone) nur schwer therapierbar. Der vorliegende Fall zeigt f\u00fcr Cefiderocol eine gute klinische Wirksamkeit \u2013 auch bei Erregern, die gegen Antibiotika wie Colistin und Ceftazidim\/Avibactam resistent sind und er verdeutlicht, wie wichtig eine antibiogrammgerechte Therapie ist.<\/jats:p>","DOI":"10.1055\/a-1975-2594","type":"journal-article","created":{"date-parts":[[2023,2,8]],"date-time":"2023-02-08T00:01:22Z","timestamp":1675814482000},"page":"170-174","source":"Crossref","is-referenced-by-count":0,"title":["Cefiderocol bei AML-Patientin mit neutropenischem Infekt durch 4MRGN Klebsiella pneumoniae (VIM-1)"],"prefix":"10.1055","volume":"148","author":[{"given":"Emanuel","family":"Urmann","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsmedizin Mainz, III. Medizinische Klinik und Poliklinik, H\u00e4matologie und medizinische Onkologie"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Stamm","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsmedizin Mainz, Zentrum f\u00fcr Kardiologie \u2013 Kardiologie 1"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jonas","family":"Wisskirchen","sequence":"additional","affiliation":[{"name":"Universit\u00e4tsmedizin Mainz, III. Medizinische Klinik und Poliklinik, H\u00e4matologie und medizinische Onkologie"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"194","published-online":{"date-parts":[[2023,2,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1311","DOI":"10.1007\/s00103-012-1549-5","article-title":"[Hygiene measures for infection or colonization with multidrug-resistant gram-negative bacilli. 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