Optimal Treatment Duration of Pseudomonas aeruginosa Infections in Allogeneic Hematopoietic Cell Transplant Recipients

Olearo, Flaminia; Kronig, Ilona; Masouridi‐Levrat, Stavroula; Chalandon, Yves; Khanna, Nina; Passweg, Jakob; Medinger, Michael; Mueller, Nicolas J.; Schanz, Urs; Delden, Christian van; Neofytos, Dionysios

doi:10.1093/ofid/ofaa246

Cited by 8 publications

(6 citation statements)

References 10 publications

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“…Hence, a shorter duration of treatment may be considered in immunocompetent patients who are showing clinical improvement and with a susceptible P. aeruginosa . However, a shorter duration may not be an option in immunocompromised patients like hematopoietic stem cell transplant (HSCT) patients who have a higher risk of recurrence if treated for less than 14 days [ 121 ]. For patients with sepsis secondary to pneumonia, we do not recommend a shortened treatment course of less than 14 days due to the high rate of recurrence in studies that compared short to long treatment durations [ 122 , 123 ].…”

Section: Key Factors Related To Therapymentioning

confidence: 99%

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

et al. 2022

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Pseudomonas aeruginosa is a pathogen often encountered in a healthcare setting. It has consistently ranked among the most frequent pathogens seen in nosocomial infections, particularly bloodstream and respiratory tract infections. Aside from having intrinsic resistance to many antibiotics, it rapidly acquires resistance to novel agents. Given the high mortality of pseudomonal infections generally, and pseudomonal sepsis particularly, and with the rise of resistant strains, treatment can be very challenging for the clinician. In this paper, we will review the latest evidence for the optimal treatment of P. aeruginosa sepsis caused by susceptible as well as multidrug-resistant strains including the difficult to treat pathogens. We will also discuss the mode of drug infusion, indications for combination therapy, along with the proper dosing and duration of treatment for various conditions with a brief discussion of the use of non-antimicrobial agents.

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Section: Key Factors Related To Therapymentioning

confidence: 99%

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

et al. 2022

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“…During the pre-engraftment phase, the depletion of neutrophils and damage to the mucosal barriers caused by conditioning regimens allow opportunistic pathogens to become infectious. The predominant pathogens during this phase are Pseudomonas, Candida and Aspergillus species (15)(16)(17)(18). During the early engraftment phase, most innate immune cell subsets such as monocytes, neutrophils, and natural killer cells repopulate at normal levels (19), but lymphocyte counts are still low.…”

Section: Clinical Phenotypes Of Infectious Pulmonary Complications Post-hctmentioning

confidence: 99%

“…Because P. aeruginosa has become increasingly resistant to multiple antibiotics over the years (33), it can be difficult to treat multidrug resistant Pseudomonal pneumonia (MDRPa) (16). About 40% of the hematologic malignancy patients infected with MDRPa will die in 30 days (34) and MDRPa outbreaks are associated with a death rate as high as 80% (35).…”

Section: Mouse Models Of Post-hct Bacterial Pneumoniamentioning

confidence: 99%

Experimental Models of Infectious Pulmonary Complications Following Hematopoietic Cell Transplantation

Zhou

Moore

2021

Front. Immunol.

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Pulmonary infections remain a major cause of morbidity and mortality in hematopoietic cell transplantation (HCT) recipients. The prevalence and type of infection changes over time and is influenced by the course of immune reconstitution post-transplant. The interaction between pathogens and host immune responses is complex in HCT settings, since the conditioning regimens create periods of neutropenia and immunosuppressive drugs are often needed to prevent graft rejection and limit graft-versus-host disease (GVHD). Experimental murine models of transplantation are valuable tools for dissecting the procedure-related alterations to innate and adaptive immunity. Here we review mouse models of post-HCT infectious pulmonary complications, primarily focused on three groups of pathogens that frequently infect HCT recipients: bacteria (often P. aeruginosa), fungus (primarily Aspergillus fumigatus), and viruses (primarily herpesviruses). These mouse models have advanced our knowledge regarding how the conditioning and HCT process negatively impacts innate immunity and have provided new potential strategies of managing the infections. Studies using mouse models have also validated clinical observations suggesting that prior or occult infections are a potential etiology of noninfectious pulmonary complications post-HCT as well.

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“…Severely immunosuppressed patients deserve specific attention. In a cohort study of allogeneic-haematopoietic cell transplant (HCT) recipients with P. aeruginosa BSIs or and/or pneumonia, treatment durations of less than 14 days were associated with more recurrent infections [78]. This may not apply to other types of immunosuppression.…”

Section: When and How To Stop Therapymentioning

confidence: 99%

Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review

et al. 2022

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Bloodstream infections (BSIs) in critically ill patients are associated with significant mortality. For patients with septic shock, antibiotics should be administered within the hour. Probabilistic treatment should be targeted to the most likely pathogens, considering the source and risk factors for bacterial resistance including local epidemiology. Source control is a critical component of the management. Sending blood cultures (BCs) and other specimens before antibiotic administration, without delaying them, is key to microbiological diagnosis and subsequent opportunities for antimicrobial stewardship. Molecular rapid diagnostic testing may provide faster identification of pathogens and specific resistance patterns from the initial positive BC. Results allow for antibiotic optimisation, targeting the causative pathogen with escalation or de-escalation as required. Through this clinically oriented narrative review, we provide expert commentary for empirical and targeted antibiotic choice, including a review of the evidence and recommendations for the treatments of extended-spectrum β-lactamase-producing, AmpC-hyperproducing and carbapenem-resistant Enterobacterales; carbapenem-resistant Acinetobacter baumannii; and Staphylococcus aureus. In order to improve clinical outcomes, dosing recommendations and pharmacokinetics/pharmacodynamics specific to ICU patients must be followed, alongside therapeutic drug monitoring.

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Optimal Treatment Duration of Pseudomonas aeruginosa Infections in Allogeneic Hematopoietic Cell Transplant Recipients

Cited by 8 publications

References 10 publications

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

Experimental Models of Infectious Pulmonary Complications Following Hematopoietic Cell Transplantation

Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review

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