Intrapleural colistin for pleural empyema due to multi-drug resistant pathogen: a case report and review of the literature

Pulmonary empyema caused by Pseudomonas aeruginosa producing Verona Integron-Encoded Metallo (VIM) β-lactamase represents a major therapeutic challenge due to the limited available therapeutic options. We reported the case of a 31-year-old patient admitted to intensive care unit (ICU) for drug intoxication, who subsequently developed aspiration pneumonia complicated by pleural empyema due to VIM-producing Pseudomonas aeruginosa . Due to clinical failure of intravenous therapy, intrapleural colistin was added, which resulted in significant clinical improvement and successful ICU discharge. This case highlights the potential role of intrapleural colistin administration in selected case of multidrug-resistant pleural infections to ensure adequate local antibiotic concentrations. Only two other similar cases with an intrapleural colistin administration have been previously reported, suggesting the need for evaluating this strategy in larger patients’ cohorts.