Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: An observational, multicenter study comparing monotherapy with combination antibiotic therapy*

Garnacho-Montero, José; Sa-Borges, Marcio; Solé‐Violán, Jordi; Barcenilla, Fernando Barroso; Escoresca‐Ortega, Ana; Ochoa, Miriam; Cayuela, Aurelio; Rello, Jordi

doi:10.1097/01.ccm.0000275389.31974.22

Cited by 242 publications

(166 citation statements)

References 31 publications

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“…The possible role of the combination therapy as a risk factor for death was the most surprising finding from the present study. This is at odds with the findings of several authors who have evaluated treatments for P. aeruginosa infection [19,21,22].…”

Section: Discussioncontrasting

confidence: 54%

“…Nevertheless, methodological precautions were taken to ensure the quality of the study. These included the use of very clear definitions for the therapy (empirical, definitive, inappropriate, delayed and combination), definitions for infections according to the NNIS criteria and use of logistic regression [22,29]. Several findings suggest that its results are coherent, such as the inversely proportional relationship between therapeutic adequacy and the likely degree of resistance; the sensitivity pattern for P. aeruginosa, which was very similar to that reported in the MYSTIC study [5] and another study conducted recently in the state of Pernambuco [27]; and, finally, the finding of greater mortality among shock patients and elderly individuals, which is compatible with the literature on severe infections.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pseudomonas aeruginosa infections: factors relating to mortality with emphasis on resistance pattern and antimicrobial treatment

Pinheiro¹,

Lacerda²,

Melo³

et al. 2008

Braz J Infect Dis

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A retrospective case-control study was conducted to investigate the risk factors for death among intensive care unit patients with Pseudomonas aeruginosa infection. Out of 131 patients investigated, 67 (51.1%) died within 30 days of being diagnosed with this infection. The mean duration of hospital stay before this diagnosis was 28.5 ± 26.5 days. No association was found between bacterial resistance and death in this study (multiresistant p= 0.26; panresistant p= 0.42), but the adequacy of the initial treatment was inversely proportional to the degree of resistance. There was a tendency towards greater mortality among patients who received combination therapy (empirical p= 0.09; definitive p= 0.08), despite the greater frequency of appropriate treatment in these patients and the similar degree of severity in the two groups. This finding may be explained by pharmacodynamic parameters that were not studied or by the extensive use of aminoglycosides in the combination therapy, which play a controversial role in combination therapy due to their potential for renal toxicity. The multivariate analysis in our study demonstrated that age [odds ratio (OR) 1.04], septic shock (OR 15.4) and hypoalbuminemia (OR 0.32) were independent risk factors for death.

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Section: Discussioncontrasting

confidence: 54%

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa infections: factors relating to mortality with emphasis on resistance pattern and antimicrobial treatment

Pinheiro¹,

Lacerda²,

Melo³

et al. 2008

Braz J Infect Dis

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show abstract

“…Initial use of combination therapy reduces the likelihood of inappropriate therapy, and has been recommended to avoid the emergence of antimicrobial resistance and to enhance the killing produced by antimicrobials acting synergistically, particularly against VAP produced by P. aeruginosa. 2 However, Garnacho-Montero et al 21 demonstrated that monotherapy with only one active antibiotic provided similar outcomes compared with combination therapy with two active antimicrobials, and suggested that switching to monotherapy once the susceptibility is documented was feasible and safe even against P. aeruginosa.…”

Section: Discussionmentioning

confidence: 99%

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

et al. 2010

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Background: Information on the characteristics of pneumonia in long-term ventilator-assisted individuals is scarce. We evaluate the incidence, risk factors and outcome of ventilator-associated pneumonia (VAP) in a large series of chronically ventilated patients. Methods: All patients assisted in a chronic ventilator-dependent unit were prospectively followed up for the development of VAP. Patients with a new and persistent lung infiltrate and a purulent tracheal aspirate were suspected to have VAP. Pneumonia was considered microbiologically confirmed in the presence of (1) a positive blood culture and/or (2) X10 5 CFU ml À1 in quantitative bacterial culture of tracheal aspirates or X10 3 CFU ml À1 in quantitative mini-bronchoalveolar lavage cultures. Results: In total, 100 consecutive long-term ventilated individuals with spinal cord injury (mean age 49 years) were prospectively followed up. The length of mechanical ventilation before admission in the unit was 54±37 days, and the follow-up after admission was 119±127 days. There were 32 episodes of VAP in 27 patients (1.74 episodes per 1000 days of mechanical ventilation). By logistic regression analysis, hypoalbuminaemia (P ¼ 0.03), administration of antacids (P ¼ 0.002) and length of mechanical ventilation (P ¼ 0.05) were independent risk factors for VAP. The most frequently isolated organisms were Pseudomonas aeruginosa (62%), methicillin-resistant Staphylococcus aureus (25%) and Acinetobacter baumannii (15%); 9 (28%) episodes were polymicrobial. Antimicrobial treatment, including monotherapy in 66%, was successful in most patients. Only three patients (11%) died in relation to VAP. Conclusions: Patients on long-term ventilation are at significant risk for the development of VAP, but the mortality is low.

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“…b The combined antibiotic therapy should consider pathogens with antibiotic resistance (such as MRSA, Pseudomonas species, and gram-negative organisms with ESBL activity) increasing the likelihood that at least one drug may be effective against that strain [187,188].…”

Section: Late Onset And/or Risk Factors For Mdr Organismsmentioning

confidence: 99%

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

Mirabile

Numico²,

Russi

et al. 2015

Critical Reviews in Oncology/Hematology

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The reporting of infection/sepsis in chemo/radiation-treated head and neck cancer patients is sparse and the problem is underestimated. A multidisciplinary group of head and neck cancer specialists from Italy met with the aim of reaching a consensus on a clinical definition and management of infections and sepsis. The Delphi appropriateness method was used for this consensus. External expert reviewers then evaluated the conclusions carefully according to their area of expertise. The paper contains seven clusters of statements about the clinical definition and management of infections and sepsis in head and neck cancer patients, which had a consensus. Furthermore, it offers a review of recent literature in these topics

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Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: An observational, multicenter study comparing monotherapy with combination antibiotic therapy*

Cited by 242 publications

References 31 publications

Pseudomonas aeruginosa infections: factors relating to mortality with emphasis on resistance pattern and antimicrobial treatment

Pseudomonas aeruginosa infections: factors relating to mortality with emphasis on resistance pattern and antimicrobial treatment

Ventilator-associated pneumonia in long-term ventilator-assisted individuals

Sepsis in head and neck cancer patients treated with chemotherapy and radiation: Literature review and consensus

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