• Tzu-Ting Chen, Shu-Mei Chen, and Hsin-Yi Liu.
• Department of Pharmacy, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan.
• Medicine (Baltimore). 2022 Jun 17; 101 (24): e29467.

IntroductionThoracic empyema and concomitant bronchopleural fistula are serious complications of pneumonia. The treatment of empyema caused by extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) has become increasingly challenging.Patients Concerns And Important Clinical FindingsA 57-year-old woman with controlled schizophrenia developed hospital-associated bacterial pneumonia secondary to P. aeruginosa on day 13 of hospitalization for brain meningioma surgery.DiagnosisChest radiography and computed tomography revealed right-sided necrotizing pneumonia with pneumothorax, a focal soft tissue defect over the right lower chest wall, and a mild right-sided encapsulated pleural effusion with consolidation. XDR-PA was isolated on empyema cultures.InterventionsThe patient was treated with intrapleural amikacin as a bridge to video-assisted thoracoscopic surgery, followed by novel ceftazidime-avibactam therapy.OutcomesOn the 104th day of admission, the patient underwent chest wall debridement and closure. The patient was discharged on day 111. Twenty-eight days after discharge, there were no observable sequelae of empyema.ConclusionAlthough the minimum inhibitory concentration of ceftazidime-avibactam for XDR-PA is relatively high (8 mg/L), this report emphasizes the efficacy of ceftazidime-avibactam treatment for XDR-PA empyema, as well as the importance of source control.Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.

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