Antibiotic therapy for pseudomonas aeruginosa bacteremia: Outcome correlations in a prospective study of 200 patients

Hilf, Megan; Yu, Victor L.; Sharp, Joann; Zuravleff, Jeffrey J.; Korvick, Joyce A.; Muder, Robert R.

doi:10.1016/0002-9343(89)90695-5

Cited by 40 publications

(61 citation statements)

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“…However, treatment of infection in immunocompromised patients may still require antibiotic suppression of regrowth of aminoglycoside-resistant subpopulations. Combination therapy of an aminoglycoside plus a /Mactam antibiotic has been frequently used in this situation (Hilf et al, 1989). Data obtained with in-vitro models of infection suggest synergistic interactions due to prevention of the emergence of resistant subpopulations by 0-lactams (Blaser et al, 19856).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of once- and thrice-daily dosing of aminoglycosides in in-vitro models of infection

Blaser¹

1991

Journal of Antimicrobial Chemotherapy

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The bactericidal efficacy of amikacin, isepamicin and netilmicin was studied against Pseudomonas aeruginosa and Serratia marcescens over a treatment period of 30 h using two one-compartment in-vitro models with differently designed culture compartments. High bacterial inocula were exposed to fluctuating drug concentrations, simulating human serum concentrations (t m -2 h) during clinical treatment. The same daily dose was administered as 1 h infusions given every 8 h or every 24 h, resulting in peak concentrations of 8 and 24 mg/1 for netilmicin, and 24 and 72 mg/1 for amikacin and isepamicin, respectively. Once-daily dosing was more bactericidal during initial treatment in the in-vitro models (P < 0-01) and at least as effective as thrice-daily dosing in preventing bacterial regrowth, despite a prolonged period of subinhibitory drug concentration before administration of the second dose. Lower ratios of peak concentration to MIC were needed to achieve bactericidal activity (> 99-9% reduction of cfu) after 24 h treatment against S. marcescens compared with P. aeruginosa (/> < 0-01). All nine regimens providing peaks of at least four times the MIC were bactericidal against S. marcescens after 24 h exposure. In contrast, a bactericidal effect against P. aeruginosa occurred only during two of six experiments with peaks of four to nine times the MIC. Similar results were obtained in both in-vitro models of infection. These data suggest insufficient intrinsic activity of the aminoglycosides studied for single drug treatment of P. aeruginosa in the absence of host-defence mechanisms.

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Section: Discussionmentioning

confidence: 99%

Efficacy of once- and thrice-daily dosing of aminoglycosides in in-vitro models of infection

Blaser¹

1991

Journal of Antimicrobial Chemotherapy

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“…The acute severity of the illness was retrospectively assessed on the day before the diagnosis of nBSIs using the Pitt bacteremia score. This is a validated index, based on mental status, need for ventilation and vital signs, which has been used in previous studies (Hilf et al, 1989;Lim et al, 2014). Source of infection was determined from clinical and microbiological data and using CDC/NHSN criteria (Horan et al, 2008).…”

Section: Variables and Definitionsmentioning

confidence: 99%

Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

Gan

Zhu

et al. 2015

J. Zhejiang Univ. Sci. B

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Abstract:In many traditional Chinese medicine (TCM) hospitals, most patients are elderly with chronic diseases. Nosocomial bloodstream infections (nBSIs) are an important cause of morbidity and mortality. A retrospective surveillance study was performed to examine the epidemiology and microbiology of nBSIs in a TCM hospital from 2009 to 2011. A total of 482 patients with nBSIs were included in the study period. The incidence rate was 5.7/1000 admissions. Escherichia coli (25.5%) was the most common Gram-negative and coagulase-negative staphylococcus (CoNS) (14.1%) was the most common Gram-positive organism isolated. One-third of the E. coli and Klebsiella pneumoniae isolated from the nBSIs were the third-generation cephalosporin-resistant. Half of the Acinetobacter species isolates were resistant to imipenem. Of all the CoNS isolates, 90.7% were resistant to methicillin. Carbapenems and glycopeptide were the most frequently used for nBSI therapy. Only about one-third of patients (157/482) received appropriate empirical therapy. Septic shock, hemodialysis, Pitt bacteremia score >4, urinary tract infection, and appropriate empirical therapy were most strongly associated with 28-d mortality. The incidence of nBSIs was low in the TCM hospital but the proportion of nBSIs due to antibiotic-resistant organisms was high. A high Pitt bacteremia score was one of the most important risk factors for mortality in nBSIs. Therefore, the implementation of appropriate empirical therapy is crucial to improve the clinical outcome of nBSIs.

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“…Empiric combination therapy for P. aeruginosa bacteremia and ventilator-associated pneumonia has resulted in lower mortality compared to monotherapy (Hilf et al, 1989;Fowler et al, 2003). A meta-analysis by Paul et al (2004) compared combination therapy with an aminoglycoside to monotherapy for severe infections and found that dual therapy did not provide a survival benefit and was associated with significantly greater rates of nephrotoxicity.…”

Section: Ajidmentioning

confidence: 99%

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

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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Antibiotic therapy for pseudomonas aeruginosa bacteremia: Outcome correlations in a prospective study of 200 patients

Cited by 40 publications

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Efficacy of once- and thrice-daily dosing of aminoglycosides in in-vitro models of infection

Efficacy of once- and thrice-daily dosing of aminoglycosides in in-vitro models of infection

Epidemiology and microbiology of nosocomial bloodstream infections: analysis of 482 cases from a retrospective surveillance study

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

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