A case of successful weaning from mechanical ventilation after inhaled tobramycin therapy for refractory Pseudomonas aeruginosa infection

Abstract

Ventilator-associated pneumonia (VAP) due to Pseudomonas aeruginosa has a high recurrence rate. We report a case of chronic P. aeruginosa infection with recurrent episodes of VAP in a patient with acute respiratory distress syndrome, which was successfully controlled by inhaled tobramycin therapy. A 66-year-old man injured his arm at work and underwent emergency surgery. He developed acute respiratory distress syndrome complicated by VAP and required long-term mechanical ventilation. On the 57th day of ICU stay, P. aeruginosa was isolated from endotracheal aspirates. He subsequently developed recurrent episodes of VAP at short intervals, resulting in prolonged mechanical ventilation. On the 192th day of ICU stay, aerosolized tobramycin therapy was started to treat the chronic P. aeruginosa infection, after which endotracheal tube aspirates showed a rapid decrease in the density of P. aeruginosa and the episodes of VAP reduced in frequency. The patient was successfully weaned off the ventilator on the 260th day of ICU stay. Inhaled tobramycin therapy is safe and may be useful for the prevention of recurrent VAP due to P. aeruginosa.