重症肌無力病人感染綠膿桿菌的治療困境：案例報告

Treatment Dilemma for a Myasthenia Gravis Patient with Carbapenem-resistant Pseudomonas aeruginosa Infection: A case report

一位56歲男性，被診斷為重症肌無力，因為出現咳嗽有痰、呼吸困難、發燒與低血壓而住院。依據臨床症狀、檢查報告與放射線檢查結果，隨即被診斷嚴重肺炎。高抗藥性綠膿桿菌被確認為其肺炎的致病菌，而且這一株綠膿桿菌對碳青黴烯也有抗藥性。由於是重症肌無力病人，相當多的抗生素都會誘發重症肌無力產生危症，而這些藥物卻是僅剩能夠對抗高抗藥性綠膿桿菌的選擇。在這個案例中，我們報告使用ceftazidime-avibactam的經驗與臨床上的困境。

A 56-year-old male with myasthenia gravis (MG) presented with productive cough, shortness of breath, and fever. Initial history, physical examination and laboratory tests were consistent with a diagnosis of severe pneumonia. The carbapenem-resistant Pseudomonas aeruginosa (CRPA) was identified to cause severe pneumonia. The CRPA was resistant to most common antibiotics, but still susceptible to gentamicin, amikacin, ciprofloxacin, levofloxacin, and colistin. With concern these susceptible antibiotics could exacerbate the MG, a novel antibiotic, ceftazidime-avibactam, was prescribed with prolonged infusion strategy. The patient showed excellent treatment response to ceftazidime-avibactam and his sepsis was resolved with an uneventful stay afterward.