Cure of limb-threatening XDR Pseudomonas aeruginosa infection: combining genome sequencing, therapeutic drug level monitoring, and surgical debridement

We describe a case of limb-threatening osteomyelitis and metalware infection with carbapenemase-producing extensively drug-resistant Pseudomonas aeruginosa successfully cured with aggressive surgical debridement and combined intravenous fosfomycin and colistin. Real-time therapeutic drug monitoring was used to maximize probability of efficacy and minimize potential for toxicity.