{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T01:01:19Z","timestamp":1788829279159,"version":"build-2803163510"},"reference-count":25,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Clin Med Insights Case Rep"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      is a frequent cause of healthcare-associated infections and is increasingly encountered in extensively drug-resistant (XDR) or pan-drug-resistant (PDR) forms. Such strains leave clinicians with virtually no therapeutic options and carry high mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case Presentation:<\/jats:title>\n                    <jats:p>\n                      We describe a 66-year-old man with chronic hypoxic respiratory failure, chronic kidney disease, and recurrent infections who was admitted with septic shock. Initial broad-spectrum antibiotics were ineffective, and cultures yielded PDR\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      , resistant to cefiderocol and with borderline colistin susceptibility (MIC 2\u2009\u00b5g\/mL). Antimicrobial susceptibility testing was performed by broth microdilution on a Thermo Fisher Sensititre\u2122 GNX3F panel, with colistin MIC confirmed by reference broth microdilution; results were interpreted per EUCAST v13.0 (2025) and CLSI M100 (2025). Despite high-dose intravenous colistin, cefiderocol, and adjunctive amikacin, the infection persisted, leading to progressive multi-organ dysfunction. Colistin dosing was adjusted for renal insufficiency and subsequently for continuous renal replacement therapy (CRRT). Meropenem (MIC 8\u2009\u00b5g\/mL; resistant) was trialed in combination with colistin for potential pharmacodynamic synergy. After 12\u2009days of intensive care, and following discussion with family, care was redirected to comfort measures, and the patient died. The cause of death was refractory septic shock due to PDR\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      with multi-organ failure.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion:<\/jats:title>\n                    <jats:p>\n                      This case illustrates the therapeutic futility posed by pan-drug-resistant (PDR)\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      . Colistin\u2019s limited efficacy at borderline MICs, compounded by renal impairment, constrained dosing. Even newer agents such as cefiderocol proved ineffective. Experimental therapies, including bacteriophages, novel \u03b2-lactamase inhibitors, and antimicrobial peptides, remain unavailable in most clinical settings.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      PDR\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      represents an urgent global threat. Until novel therapies become accessible, stringent stewardship, infection control, and preventive strategies remain the most effective defenses.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11795476251411094","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T07:01:13Z","timestamp":1769065273000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Pan-Resistant\n                    <i>Pseudomonas aeruginosa<\/i>\n                    Septic Shock in a Critically Ill Patient: A Case Report"],"prefix":"10.1177","volume":"19","author":[{"given":"Arihant","family":"Surana","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riya","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Houman","family":"Javady","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurman","family":"Bhullar","sequence":"additional","affiliation":[{"name":"Sri Guru Ram Das University of Health Science and Research, Amritsar, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prajnasini","family":"Satapathy","sequence":"additional","affiliation":[{"name":"Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arun","family":"Kumar","sequence":"additional","affiliation":[{"name":"Faculty of Pharmaceutical Sciences, Graphic Era Hill University, Dehradun, India"},{"name":"Centre for Promotion of Research, Graphic Era Deemed University, Dehradun, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sorabh","family":"Lakhanpal","sequence":"additional","affiliation":[{"name":"School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakasini","family":"Satapathy","sequence":"additional","affiliation":[{"name":"University Center for Research and Development, Chandigarh University, Mohali, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rekha","family":"Arcot","sequence":"additional","affiliation":[{"name":"Dr. D. Y. Patil Medical College Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth (Deemed-to-be-University), Pimpri, Pune, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6921-7828","authenticated-orcid":false,"given":"Rodrigue","family":"Ndabashinze","sequence":"additional","affiliation":[{"name":"University of Burundi, Bujumbura, Burundi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2499-4874","authenticated-orcid":false,"given":"Amogh","family":"Verma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Rama Medical College Hospital and Research Center, Hapur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,21]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12866-024-03321-5"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/jb.00054-24"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12030562"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.53350\/pjmhs221695"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2024.04.002"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/pathogens13110975"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.7453\/gahmj.2013.008"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.advms.2024.05.001"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.915958"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics13020119"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics11020193"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-070491"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.896971"},{"key":"e_1_3_3_15_2","first-page":"17567","article-title":"Synergistic antibacterial activity of ceftazidime\u2013avibactam in combination with colistin, gentamicin, amikacin, and fosfomycin against carbapenem-resistant","volume":"14","author":"T\u00fczemen N\u00dc","year":"2024","unstructured":"T\u00fczemen N\u00dc, \u00d6nal U, Merdan O, et al. Synergistic antibacterial activity of ceftazidime\u2013avibactam in combination with colistin, gentamicin, amikacin, and fosfomycin against carbapenem-resistant Klebsiella pneumoniae. Sci Rep. 2024;14:17567.","journal-title":"Klebsiella pneumoniae. 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