Current Problems in the Treatment of Infective Endocarditis Due to Pseudomonas aeruginosa

Reyes, Milagros P.; Lerner, A. Martin

doi:10.1093/clinids/5.2.314

Cited by 112 publications

(66 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The combination of ticarcillin and tobramycin is the recommended antimicrobial therapy for patients with P. aeruginosa endocarditis (16). More than 80% of patients with right-sided disease can be cured with this combination, but the outcome for left-sided involvement remains poor (16).…”

Section: Discussionmentioning

confidence: 99%

“…More than 80% of patients with right-sided disease can be cured with this combination, but the outcome for left-sided involvement remains poor (16). In this study, we defined the in vitro inhibitory, bactericidal, and synergistic activities of drugs from three 3-lactam classes against strains of P. aeruginosa isolated from patients with P. aeruginosa endocarditis to determine whether any of these agents compared favorably with ticarcillin.…”

Section: Discussionmentioning

confidence: 99%

“…Reyes and Lerner have reported that the azlocillin-aminoglycoside combination is consistently synergistic against their P. aeruginosa strains that cause endocarditis but that therapeutic results are disappointing when piperacillin is substituted for ticarcillin in vivo (16). Other ,B-lactams with antipseudomonal activity should also be studied with similar methods and time-kill curves.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

In vitro studies of investigational beta-lactams as possible therapy for Pseudomonas aeruginosa endocarditis

Zar¹,

Kany²

1985

Antimicrob Agents Chemother

View full text Add to dashboard Cite

The inadequacy of the present medical therapy of Pseudomonas aeruginosa endocarditis prompted an investigation of the in vitro activities of aztreonam, cefsulodin, and imipenem compared with that of ticarcillin against 37 strains of P. aeruginosa isolated from patients with endocarditis. Inhibitory and bactericidal activities were studied for each I-lactam alone and in combination with tobramycin. All agents showed excellent inhibitory activity. Imipenem was the most inhibitory P-lactam yet lacked inhibitory synergy against 95% of the strains and bactericidal synergy against 62%. Tolerance to imipenem was seen in six strains. Aztreonam alone was bactericidal against 46% of the strains (at 16 ,ug/ml) and showed bactericidal synergy in 70%. Cefsulodin alone was even less active but similar to aztreonam synergistically. Ticarcillin and tobramycin inhibited all strains as single agents and showed universal bactericidal synergy in combination. None of the new I-lactams showed consistent superiority to the presently used agent, ticarcillin.Pseudomonas aeruginosa endocarditis often responds poorly to present medical therapy with an antipseudomonal penicillin and an aminoglycoside (16). Investigational Plactams of the cephalosporin, monobactam, and carbapenem classes have considerable inhibitory activity against P. aeruginosa in vitro. However, there is little information available concerning their bactericidal and synergistic activities in combination with an aminoglycoside. Both of these properties are important in determining whether these agents may offer an advantage over current therapy or at least an equipotent alternative in penicillin-allergic patients with P. aeruginosa endocarditis.We therefore investigated the inhibitory and bactericidal activities of aztreonam, cefsulodin, and imipenem alone and in combination with tobramycin against 37 strains of P. aeruginosa isolated from patients with P. aeruginosa endocarditis to determine whether they compared favorably in vitro with the present therapeutic regimen of ticarcillin and tobramycin. MATERIALS AND METHODSOrganisms and patients. Strains of P. aeruginosa were isolated from blood or excised cardiac valves of patients with a diagnosis of P. aeruginosa endocarditis seen at the University of Illinois Hospitals from 1979 through 1983. Diagnostic criteria for P. aeruginosa endocarditis included persistent P. aeruginosa bacteremia and absence of an obvious source other than the heart (17). All patients were intravenous drug users. Duplicate isolates from the same patient were excluded unless they differed in serotype (three instances). The isolates were identified by standard criteria (8).Serotyping. Serotyping was performed by slide agglutination with live P. aeruginosa organisms picked from blood agar plates with antisera against the 17 0 antigens of the International Antigenic Typing Scheme (3). Antisera were obtained from Difco Laboratories (Detroit, Mich. Susceptibility testing. MICs of the five antibiotics were determined for each organism in microtiter wells...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

In vitro studies of investigational beta-lactams as possible therapy for Pseudomonas aeruginosa endocarditis

Zar¹,

Kany²

1985

Antimicrob Agents Chemother

View full text Add to dashboard Cite

show abstract

“…P. aeruginosa can cause infections of the ear, bone, joint, skin and soft tissue, and more serious infections, including meningitis, bacteraemia, endocarditis, ocular infections, hospital-acquired pneumonia, and lung infections in cystic fibrosis (CF) patients (Baltch & Griffin, 1977;Bowton, 1999;Fleiszig et al, 1995;Greenberger, 1997;Lode et al, 2000;Pruitt et al, 1998;Reyes & Lerner, 1983;Richards et al, 1999;Schaberg et al, 1991). P. aeruginosa lung infections transpire in nosocomial pneumonia and in CF patients.…”

Section: Introductionmentioning

confidence: 99%

The Pseudomonas aeruginosa PsrA responds to long-chain fatty acid signals to regulate the fadBA5 β-oxidation operon

et al. 2008

View full text Add to dashboard Cite

The Pseudomonas aeruginosa PsrA responds to long-chain fatty acid signals to regulate the fadBA5 b-oxidation operon b-Oxidative enzymes for fatty acid degradation (Fad) of long-chain fatty acids (LCFAs) are induced in vivo during lung infection in cystic fibrosis patients, and this may contribute to nutrient acquisition and pathogenesis of Pseudomonas aeruginosa. The promoter region of one P. aeruginosa b-oxidation operon, fadBA5 (PA3014 and PA3013), was mapped. Focusing on the transposon mutagenesis of strain PAO1 carrying the P fadBA5 -lacZ fusion, a regulator for the fadBA5 operon was identified to be PsrA (PA3006). Transcriptome analysis of the DpsrA mutant indicated its importance in regulating b-oxidative enzymes. These microarray data were confirmed by real-time RT-PCR analyses of the fadB5 and lipA (encoding a lipase) genes. Induction of the fadBA5 operon was demonstrated to respond to novel LCFA signals, and this induction required the presence of PsrA, suggesting that LCFAs bind to PsrA to derepress fadBA5. Electrophoretic mobility shift assays indicate specific binding of PsrA to the fadBA5 promoter region. This binding is disrupted by specific LCFAs (C 18 : 1 D9 , C 16 : 0 , C 14 : 0 and, to a lesser extent, C 12 : 0 ), but not by other medium-or short-chain fatty acids or the first intermediate of b-oxidation, acyl-CoA. It is shown here that PsrA is a fadBA5 regulator that binds and responds to LCFA signals in P. aeruginosa. INTRODUCTIONPseudomonas aeruginosa is an opportunistic pathogen, and the spectrum of infections and diseases it causes is second to none. P. aeruginosa can cause infections of the ear, bone, joint, skin and soft tissue, and more serious infections, including meningitis, bacteraemia, endocarditis, ocular infections, hospital-acquired pneumonia, and lung infections in cystic fibrosis (CF) patients (Baltch & Griffin, 1977;Bowton, 1999;Fleiszig et al., 1995;Greenberger, 1997;Lode et al., 2000;Pruitt et al., 1998;Reyes & Lerner, 1983;Richards et al., 1999;Schaberg et al., 1991). P. aeruginosa lung infections transpire in nosocomial pneumonia and in CF patients. Nosocomial pneumonia is the second most common of all nosocomial infections, and P. aeruginosa has been the most frequently isolated microbe responsible (Pennington, 1994;Richards et al., 1999). In addition, over 93 % of CF patients between the ages of 18 and 24 have been infected with P. aeruginosa (Doring, 1997).Fatty acid degradation (Fad) pathways may play critical roles in P. aeruginosa pathogenesis. It has recently been demonstrated that the Fad pathways of P. aeruginosa may have important implications in nutrient acquisition and pathogenesis within the CF lung (Son et al., 2007), through the degradation of an essential lung surfactant component phosphatidylcholine (PC). The degradation of one PC component, long-chain fatty acid (LCFA), potentially occurs through three different b-oxidation pathways, involving three fadBA operons (fadAB1, PA1737 and PA1736; fadAB4, PA4786 and PA4785; and fadBA5, PA3014 and PA3013) (Son e...

show abstract

“…aeruginosa accounted for 10-13.5% of endocarditis cases in Injection Drug Users (IDUs) between 1969 and 1984 [31,32]. Between 1969 and 1975, among 37 cases of PsE seen at the DMC, tricuspid valve was involved in 70% (26/37) and 22% (8/37) had left-sided disease [33]. Three patients (3/37; 8%) had both left-and right-sided involvement.…”

Section: Pseudomonas Endocarditismentioning

confidence: 99%

Current Perspectives: Therapeutic Uses of Tobramycin

Reyes¹,

Zhao²,

Buensalido³

2014

J Pharmacovigilance

View full text Add to dashboard Cite

show abstract

Current Problems in the Treatment of Infective Endocarditis Due to Pseudomonas aeruginosa

Cited by 112 publications

References 19 publications

In vitro studies of investigational beta-lactams as possible therapy for Pseudomonas aeruginosa endocarditis

In vitro studies of investigational beta-lactams as possible therapy for Pseudomonas aeruginosa endocarditis

The Pseudomonas aeruginosa PsrA responds to long-chain fatty acid signals to regulate the fadBA5 β-oxidation operon

Current Perspectives: Therapeutic Uses of Tobramycin

Contact Info

Product

Resources

About