TABLE 4.
Details of six patients with B. pseudomallei isolates resistant or less susceptible to β-lactam antibioticsa
| Patient no. (study hospital) | Clinical presentation and medical history | Day and type of specimen collection after admission | Isolate ID (antibiotic susceptibility result) | Treatment received after admission in study hospital |
Patient status | ||
|---|---|---|---|---|---|---|---|
| Antibiotic | Start (day) | End (day) | |||||
| 1* (hospital A) | Fever, underlying diabetes mellitus, history of left lobectomy, required mechanical ventilation, empyema thoracis, and bronchopleural fistula (consecutive drainages done on days 8, 9, 23, and 36); coinfected with MDR A. baumannii; patient was provisionally treated as melioidosis and had received an unknown duration of CAZ in a referral hospital | 9 (pleural fluid) | DR10212A (CAZ-R, MEM-LS, SXT-R) | MEM | 0 | 13 | Died at day 40 |
| MEM | 21 | 39 | |||||
| AMC | 13 | 22 | |||||
| 2* (hospital C) | Poorly controlled type 2 diabetes mellitus and fever; patient had received CTR (3 days) and CAZ (9 days) from a referral hospital | 0 (blood) | DR30013A (CAZ-R) | CAZ | 0 | 7 | Died at day 9 |
| SXT | 4 | 9 | |||||
| CST | 4 | 5 | |||||
| MEM | 7 | 9 | |||||
| VAN | 5 | 6 | |||||
| VAN | 8 | 9 | |||||
| 3 (hospital E) | Underlying TB with ongoing treatment, hemoptysis, chronic obstructive lung disease, and renal impairment | 1 (sputum) | DR50054A (S) | CAZ | 0 | 16 | Discharged at day 22 with home oral AMC |
| AZM | 0 | 4 | |||||
| STR | 1 | 21 | |||||
| SXT | 12 | 19 | |||||
| Relapsed infection | 354 days after first episode (sputum) | DR50054E (CAZ-R, MEM-LS, AMC-R) | NA | NA | NA | Relapse | |
| 4* (hospital H) | Dysuria, renal calculi; patient had received unknown duration of AMC from a referral hospital | −3 (urine) | DR80110A (AMC-R) | CAZ | 0 | 13 | Discharged at day 13 with home oral SXT |
| SXT | 10 | 13 | |||||
| 5* (hospital I) | Fever, history of foot wound exposure to soil and carotid space abscess; patient was diagnosed with hypertensive emergency, cardiomegaly, and pulmonary congestion | 1 (blood) | DR90031A (S) | CTR | 0 | 1 | Discharged at day 6 with home oral SXT and AMC |
| AMC | 1 | 6 | |||||
| Relapsed infection | 520 days after first episode (pus) | DR90031E (MEM-LS) | NA | NA | NA | Relapse | |
| 6 (hospital I) | History of melioidosis 2 yrs earlier, fever, and splenic abscess | 1 (blood) | DR90049A (MEM-LS) | CTR | 0 | 2 | Discharged at day 15 with home oral SXT |
| DOX | 0 | 2 | |||||
| CAZ | 2 | 15 | |||||
a
MDR, multidrug resistant; TB, tuberculosis; MEM, meropenem; AMC, amoxicillin-clavulanic acid; CFZ, cefazolin; CAZ, ceftazidime; AZM, azithromycin; SXT, trimethoprim-sulfamethoxazole; CST, colistin; VAN, vancomycin; STR, streptomycin; CTR, ceftriaxone; DOX, doxycycline; S, susceptible; LS, less susceptible; R, resistant; NA, not available; *, transferred from referring hospitals.