Identification of Optimal Combinations for Empirical Dual Antimicrobial Therapy of Pseudomonas aeruginosa Infection: Potential Role of a Combination Antibiogram

Mizuta, Mari; Linkin, Darren R.; Nachamkin, Irving; Fishman, Neil O.; Weiner, Mark G.; Sheridan, Angela; Lautenbach, Ebbing

doi:10.1086/503175

Cited by 29 publications

(32 citation statements)

References 14 publications

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“…A study by Mizuta et al (2006) compared the susceptibility results of 3,134 P. aeruginosa isolates to determine optimal combinations for P. aeruginosa infections in hospitalized patients. They concluded the optimal combination therapy consisted of an aminoglycoside and a betalactam.…”

Section: Discussionmentioning

confidence: 99%

“…To assist clinicians in selecting the most effective twodrug antibiotic regimen, combination antibiograms have been employed (Apisarnthanarak and Mundy, 2008;Christoff et al, 2010;Fox et al, 2008;Mizuta et al, 2006;Pogue et al, 2011). These antibiograms can be displayed in matrix form showing the percentage of isolates susceptible to various single agents and combinations of antibiotics.…”

Section: Ajidmentioning

confidence: 99%

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UTILITY OF A COMBINATION ANTIBIOGRAM FOR TREATING PSEUDOMONAS AERUGINOSA

Thurman¹

2014

American Journal of Infectious Diseases

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Empiric combination antibiotic therapy is often used to treat severe P. aeruginosa infections. Combination antibiograms have been employed to assist clinicians in selecting the most effective two-drug antibiotic regimens. The objectives of this study were to develop a combination antibiogram in order to compare betalactam monotherapy versus dual-therapy with a fluoroquinolone or aminoglycoside, identify optimal combination regimens, describe the differences between combination therapies with an aminoglycoside versus a fluoroquinolone and to evaluate susceptibility rates based on the source of infection and Intensive Care Unit (ICU) or non-ICU location. A retrospective observational study at a Veterans Affairs (VA) hospital in the Southwestern region of the U.S. was conducted. P. aeruginosa isolates were collected between January 2008 and February 2012 in hospitalized veterans. A total of 374 isolates were included, of which 61 (16%) were obtained from the ICU. Susceptibility rates for monotherapy with a beta-lactam ranged from 83.7 to 90.6%. Collectively, all P. aeruginosa isolates benefited in coverage with the addition of a fluoroquinolone or an aminoglycoside to one of the beta-lactams considered for monotherapy (p<0.01 for each comparison). Monotherapy with a beta-lactam could be considered for mild to moderate wound infections which had beta-lactam susceptibility rates greater than 90% and the addition of a fluoroquinolone did not significantly extend the spectrum. Combination susceptibility rates ranged from 89.0 to 99.2%. Dual therapy of a beta-lactam with amikacin or tobramycin resulted in significantly better coverage than with a fluoroquinolone (p<0.03 for all combinations). For severe infections dual therapy with tobramycin or amikacin may be preferred over fluoroquinolones, but the risks versus benefits of aminoglycoside therapy must be weighed for each patient. In conclusion, combination antibiograms are useful for evaluating the treatment of P. aeruginosa. Choosing the ideal antibiotic regimen ultimately deals with many factors and results of this combination antibiogram are only specific to this institution.

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Section: Discussionmentioning

confidence: 99%

Section: Ajidmentioning

confidence: 99%

UTILITY OF A COMBINATION ANTIBIOGRAM FOR TREATING PSEUDOMONAS AERUGINOSA

Thurman¹

2014

American Journal of Infectious Diseases

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“…A 2-drug combination of a β -lactam antibiotic and an aminoglycoside antibiotic was reported to be effective against P. aeruginosa [16,19,23-27]. However, for multidrug-resistant P. aeruginosa , 3-drug combinations such as that of aztreonam, ceftazidime and amikacin rather than 2-drug combinations were shown to exhibit more marked in vitro antimicrobial effects [8,9].…”

Section: Discussionmentioning

confidence: 99%

In vitro antimicrobial effects of aztreonam, colistin, and the 3-drug combination of aztreonam, ceftazidime and amikacin on metallo-β-lactamase-producing Pseudomonas aeruginosa

et al. 2009

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BackgroundThere are limited choice of antimicrobial agents to treat infection with metallo-β-lactamase-producing Pseudomonas aeruginosa. We evaluate the antimicrobial effects of aztreonam alone, colistin alone and the 3-drug combination of aztreonam, ceftazidime and amikacin on 23 strains of metallo-β-lactamase-producing P. aeruginosa by time-killing tests.MethodsStrains used were from different hospitals in Japan and had different pulse-field gel electrophoresis patterns by restriction with SpeI. The minimum inhibitory concentrations of 11 antimicrobial agents (piperacillin, piperacillin/tazobactam, imipenem, meropenem, aztreonam, ceftazidime, amikacin, tobramycin, arbekacin, ciprofloxacin and colistin) were determined using the agar dilution test. The effects of aztreonam, colistin and the combination of aztreonam, ceftazidime and amikacin were determined by time-killing studies.ResultsBacteriostatic effects after 6 hours of drug exposure were observed in 12 strains (52.2%) of 23 strains of metallo-β-lactamase-producing P. aeruginosa with 48 mg/l aztreonam, in 19 strains (82.6%) with the 3-drug combination of 16 mg/l aztreonam, 16 mg/l ceftazidime, and 4 mg/l amikacin, and in 23 strains (100%) with 2 mg/l colistin. Bactericidal effects after 6 h drug exposure were observed in 1 strain (4.3%) with 48 mg/l aztreonam, in 8 strains (30.4%) with the 3-drug combination and in all 23 strains (100%) with 2 mg/l colistin.ConclusionEvaluation of in vitro antimicrobial effects on metallo-β-lactamase-producing P. aeruginosa revealed relatively good effects of the 3-drug combination of aztreonam, ceftazidime and amikacin and marked effects of colistin.

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“…To the Editor-We read with interest the report by Mizuta and colleagues 1 on the role of a combination antibiogram for empirical treatment of Pseudomonas aeruginosa infection. The emergence of multidrug-resistant (MDR) gramnegative microorganisms, especially Acinetobacter baumannii, has created prescribing dilemmas for physicians trying to select empirical therapy.…”

Section: Role Of Combination Antibiogram In Empirical Treatment Of Inmentioning

confidence: 99%

“…We created a standard antibiogram for A. baumannii isolates, along with annual combination antibiograms created in a matrix fashion, which listed the antimicrobial agents tested both horizontally and vertically, as had been previously done by Mizuta and colleagues. 1 In each matrix box of the combination antibiogram, we noted the percentage of isolates susceptible to at least 1 of the 2 agents (Table). The backbone of noncolistin-based, 2-antibiotic regimens for triple antimicrobial agents was selected from the 2 antibiotics to which MDR-A.…”

Section: Role Of Combination Antibiogram In Empirical Treatment Of Inmentioning

confidence: 99%

Role of Combination Antibiogram in Empirical Treatment of Infection Due to Multidrug-Resistant Acinetobacter baumannii

Apisarnthanarak

Mundy

2008

Infect. Control Hosp. Epidemiol.

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Identification of Optimal Combinations for Empirical Dual Antimicrobial Therapy of Pseudomonas aeruginosa Infection: Potential Role of a Combination Antibiogram

Cited by 29 publications

References 14 publications

UTILITY OF A COMBINATION ANTIBIOGRAM FOR TREATING <i>PSEUDOMONAS AERUGINOSA</i>

UTILITY OF A COMBINATION ANTIBIOGRAM FOR TREATING <i>PSEUDOMONAS AERUGINOSA</i>

In vitro antimicrobial effects of aztreonam, colistin, and the 3-drug combination of aztreonam, ceftazidime and amikacin on metallo-β-lactamase-producing Pseudomonas aeruginosa

Role of Combination Antibiogram in Empirical Treatment of Infection Due to Multidrug-Resistant Acinetobacter baumannii

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