Ceftolozane-tazobactam, a novel fifth-generation cephalos-porin and p-lactamase inhibitor, with activity against multi-drug resistant Pseudomonas aeruginosa, has recently been evaluated by Maraolo and colleagues for such infections in the intensive care unit 1. We describe a cautionary case of fatal Pseudomonal pneumonia, involving the rapid development of ceftolozane-tazobactam resistance in vivo.An elderly gentleman was admitted with septic shock due to fecal peritonitis associated with Enterococcus faecium bac-teraemia, treated with meropenem and vancomycin. A month following admission, sputum cultured P. aeruginosa, resistant to meropenem, aztreonam, and ciprofloxacin (Table 1), with no strains of resistant P. aeruginosa known to be circulating the facility at the time.
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