Pseudomonas aeruginosa infections in the Intensive Care Unit: can the adequacy of empirical β-lactam antibiotic therapy be improved?

Bhat, Sunil; Fujitani, Shigeki; Potoski, Brian A.; Capitano, Blair; Linden, Peter K.; Shutt, Kathleen A.; Paterson, David L.

doi:10.1016/j.ijantimicag.2007.05.022

Cited by 39 publications

(28 citation statements)

References 6 publications

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“…There is evidence supporting the initial use of combination therapy for severe infections with Gram-negative bacteria, such as sepsis or ventilator-associated pneumonia (VAP), in the existing environment of MDRGNs because of the broad empiric coverage provided by two antimicrobial agents with different spectra of activity (20,33,89,116,117,134,136,153,246). However, when identification and susceptibility testing results are known, an argument can be made that the antibiotic regimen for Gram-negative organisms can be "fine-tuned" and narrowed in many cases (20,134).…”

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confidence: 99%

“…Observational studies show that between 25 and 50% of patients with bacteremia, surgical site infections, or pneumonia and over 50% of patients with septic shock in the intensive care unit (ICU) are administered combination antibiotic therapy (20,54,100,117,134,138,152,173,228,246). The question of whether a combination of a ␤-lactam and an aminoglycoside or fluoroquinolone confers a benefit in patients beyond broadening the antimicrobial spectrum during the empiric treatment period before culture results are available is unsettled.…”

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confidence: 99%

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Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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SUMMARY Combination antibiotic therapy for invasive infections with Gram-negative bacteria is employed in many health care facilities, especially for certain subgroups of patients, including those with neutropenia, those with infections caused by Pseudomonas aeruginosa , those with ventilator-associated pneumonia, and the severely ill. An argument can be made for empiric combination therapy, as we are witnessing a rise in infections caused by multidrug-resistant Gram-negative organisms. The wisdom of continued combination therapy after an organism is isolated and antimicrobial susceptibility data are known, however, is more controversial. The available evidence suggests that the greatest benefit of combination antibiotic therapy stems from the increased likelihood of choosing an effective agent during empiric therapy, rather than exploitation of in vitro synergy or the prevention of resistance during definitive treatment. In this review, we summarize the available data comparing monotherapy versus combination antimicrobial therapy for the treatment of infections with Gram-negative bacteria.

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Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

2012

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“…Although we saw increased rates of resistance in the first relapse BSI patient group, this did not reach statistical significance. Bhat et al showed that in their retrospective cohort of ICU patients with a P. aeruginosa isolate that was resistant to piperacillin-tazobactam or cefepime, that the patient was more likely to have received these antibiotics in the month prior to the P. aeruginosa infection or to have had a gram-negative bacillus resistant to these antibiotics isolated in the month prior to the P. aeruginosa infection [18]. We found that the group of primary BSI relapse patients was significantly more likely to have received anti-pseudomonal beta-lactams in the preceding 30 days.…”

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Increased risk of death with recurrent Pseudomonas aeruginosa bacteremia

McCarthy

Paterson

2017

Diagnostic Microbiology and Infectious Disease

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“…Of the various b-lactam agents evaluated for children bacteremic with MDRGNs, meropenem had the broadest spectrum of activity at 83% with the susceptibility of other agents ranging from 38% (ceftriaxone) to 66% (cefepime). When a patient has risk factors for MDRGNs (eg, a history of previous colonization or infection with an MDRGN, broad-spectrum antibiotic therapy within 30 days, a prolonged current hospitalization, or a high prevalence of MDRGNs in the community), 27,28 the addition of an aminoglycoside as empirical therapy appears prudent.…”

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confidence: 99%

Empiric Combination Therapy for Gram-Negative Bacteremia

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT:Existing data do not demonstrate a need for combination therapy after antimicrobial susceptibility data indicate adequate in vitro activity with b-lactam monotherapy. However, the role of empirical combination therapy for the treatment of Gram-negative bacteremia in children remains unsettled. WHAT THIS STUDY ADDS:We conducted a retrospective, propensityscore matched study demonstrating no improvement in 10-day mortality of children who have Gram-negative bacteremia receiving empirical b-lactam and aminoglycoside combination therapy compared with b-lactam monotherapy, unless the bacteremic episode was attributable to a multidrug-resistant organism. METHODS:We conducted a retrospective cohort study of children treated for Gram-negative bacteremia at The Johns Hopkins Hospital from 2004 through 2012. We compared the estimated odds of 10-day mortality and the relative duration of bacteremia for children receiving empirical combination therapy versus empirical monotherapy using 1:1 nearest-neighbor propensity-score matching without replacement, before performing regression analysis. RESULTS:We identified 226 matched pairs of patients well balanced on baseline covariates. Ten-day mortality was similar between the groups (odds ratio, 0.84; 95% confidence interval [CI], 0.28 to 1.71). Use of empirical combination therapy was not associated with a decrease in the duration of bacteremia (20.51 days; 95% CI, 22.22 to 1.48 days). There was no survival benefit when evaluating 10-day mortality for the severely ill (pediatric risk of mortality III score $15) or profoundly neutropenic patients (absolute neutrophil count #100 cells/mL) receiving combination therapy. However, a survival benefit was observed when empirical combination therapy was prescribed for children growing multidrug-resistant Gram-negative organisms from the bloodstream (odds ratio, 0.70; 95% CI, 0.51 to 0.84). CONCLUSIONS:Although there appears to be no advantage to the routine addition of an aminoglycoside to a b-lactam as empirical therapy for children who have Gram-negative bacteremia, children who have risk factors for MDRGN organisms appear to benefit from this practice.

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Pseudomonas aeruginosa infections in the Intensive Care Unit: can the adequacy of empirical β-lactam antibiotic therapy be improved?

Cited by 39 publications

References 6 publications

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Combination Therapy for Treatment of Infections with Gram-Negative Bacteria

Increased risk of death with recurrent Pseudomonas aeruginosa bacteremia

Empiric Combination Therapy for Gram-Negative Bacteremia

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