Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

Zakhour, Johnny; Sharara, Sima L.; Hindy, Joya-Rita; Haddad, Samuel; Kanj, Souha S.

doi:10.3390/antibiotics11101432

Cited by 20 publications

(14 citation statements)

References 156 publications

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“…Based on most expert opinion, a combination of antibiotics is recommended to manage infections due to P. aeruginosa , especially in the case of severe infections [ 8 , 9 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Association between combination antibiotic therapy as opposed as monotherapy and outcomes of ICU patients with Pseudomonas aeruginosa ventilator-associated pneumonia: an ancillary study of the iDIAPASON trial

et al. 2023

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Background The optimal treatment duration and the nature of regimen of antibiotics (monotherapy or combination therapy) for Pseudomonas aeruginosa ventilator‑associated pneumonia (PA-VAP) remain debated. The aim of this study was to evaluate whether a combination antibiotic therapy is superior to a monotherapy in patients with PA-VAP in terms of reduction in recurrence and death, based on the 186 patients included in the iDIAPASON trial, a multicenter, randomized controlled trial comparing 8 versus 15 days of antibiotic therapy for PA-VAP. Methods Patients with PA-VAP randomized in the iDIAPASON trial (short-duration—8 days vs. long-duration—15 days) and who received appropriate antibiotic therapy were eligible in the present study. The main objective is to compare mortality at day 90 according to the antibiotic therapy received by the patient: monotherapy versus combination therapy. The primary outcome was the mortality rate at day 90. The primary outcome was compared between groups using a Chi-square test. Time from appropriate antibiotic therapy to death in ICU or to censure at day 90 was represented using Kaplan–Meier survival curves and compared between groups using a Log-rank test. Results A total of 169 patients were included in the analysis. The median duration of appropriate antibiotic therapy was 14 days. At day 90, among 37 patients (21.9%) who died, 17 received monotherapy and 20 received a combination therapy (P = 0.180). Monotherapy and combination antibiotic therapy were similar for the recurrence rate of VAP, the number of extra pulmonary infections, or the acquisition of multidrug-resistant (MDR) bacteria during the ICU stay. Patients in combination therapy were exposed to mechanical ventilation for 28 ± 12 days, as compared with 23 ± 11 days for those receiving monotherapy (P = 0.0243). Results remain similar after adjustment for randomization arm of iDIAPASON trial and SOFA score at ICU admission. Conclusions Except longer durations of antibiotic therapy and mechanical ventilation, potentially related to increased difficulty in achieving clinical cure, the patients in the combination therapy group had similar outcomes to those in the monotherapy group. Trial registration: NCT02634411, Registered 15 December 2015.

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“…Based on most expert opinion, a combination of antibiotics is recommended to manage infections due to P. aeruginosa , especially in the case of severe infections [ 8 , 9 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

Association between combination antibiotic therapy as opposed as monotherapy and outcomes of ICU patients with Pseudomonas aeruginosa ventilator-associated pneumonia: an ancillary study of the iDIAPASON trial

et al. 2023

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“…However, as anaerobic pathogens are more difficult to be isolated in the laboratory without proper transport media, coverage for such pathogens need to be continued particularly if aerobic Gram-negative pathogens are isolated or if clinical signs of skin crepitus, black skin discoloration or loss of sensation are present. Empiric antipseudomonal antimicrobials should be promptly initiated in the presence of risk factors for P. aeruginosa infection given its association with high mortality in severe infections [34].…”

Section: Medical Managementmentioning

confidence: 99%

Community-acquired skin and soft-tissue infections in people who inject drugs

Allaw¹,

Zakhour²,

Kanj³

2023

Current Opinion in Infectious Diseases

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Purpose of reviewThe aim of this review is to discuss the latest evidence of the epidemiology, microbiology, risk factors, diagnosis and management of community-acquired skin and soft tissue infections (SSTIs) in people who inject drug (PWID). Recent findingsSSTIs are common complications in PWID and a major cause of morbidity and mortality. Infections can range from uncomplicated cellulitis, to abscesses, deep tissue necrosis and necrotizing fasciitis. They are predominantly caused by Gram-positive pathogens in particular Staphylococcus aureus and Streptococcus species; however, toxin-producing organisms such as Clostridium botulism or Clostridium tetani should be considered. The pathogenesis of SSTI in the setting of intravenous drug use (IDU) is different from non-IDU related SSTI, and management often requires surgical interventions in addition to adjunctive antibiotics. Harm reduction strategies and education about safe practices should be implemented to prevent morbidity and mortality as well as healthcare burden of SSTI in PWID. SummaryPrompt diagnosis and proper medical and surgical management of SSTI will improve outcomes in PWID.

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“…On the other hand, Pseudomonas aeruginosa is rarely a causative organism of infective endocarditis [ 77 ]. However, empirical antipseudomonal therapy should be initiated in critically ill patients with risk factors for P. aeruginosa infection [ 78 ]. A combination of a beta-lactam agent such as ceftazidime, cefepime, or piperacillin-tazobactam in addition to vancomycin and an aminoglycoside (gentamicin or amikacin) is appropriate.…”

Section: Antimicrobial Treatmentmentioning

confidence: 99%

Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management

et al. 2023

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Although initially conceived for high-risk patients who are ineligible for surgical aortic valve replacement (SAVR), transcatheter aortic valve replacement (TAVR) is now recommended in a wider spectrum of indications, including among young patients. However, similar to SAVR, TAVR is also associated with a risk of infectious complications, namely, prosthetic valve endocarditis (PVE). As the number of performed TAVR procedures increases, and despite the low incidence of PVE post-TAVR, clinicians should be familiar with its associated risk factors and clinical presentation. Whereas the diagnosis of native valve endocarditis can be achieved straightforwardly by applying the modified Duke criteria, the diagnosis of PVE is more challenging given its atypical symptoms, the lower sensitivity of the criteria involved, and the low diagnostic yield of conventional echocardiography. Delay in proper management can be associated with increased morbidity and mortality. Therefore, clinicians should have a high index of suspicion and initiate proper work-up according to the severity of the illness, the underlying host, and the local epidemiology of the causative organisms. The most common causative pathogens are Gram-positive bacteria such as Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., and Streptococcus spp. (particularly the viridans group), while less-likely causative pathogens include Gram-negative and fungal pathogens. The high prevalence of antimicrobial resistance complicates the choice of therapy. There remain controversies regarding the optimal management strategies including indications for surgical interventions. Surgical assessment is recommended early in the course of illness and surgical intervention should be considered in selected patients. As in other PVE, the duration of therapy depends on the isolated pathogen, the host, and the clinical response. Since TAVR is a relatively new procedure, the outcome of TAVR-PVE is yet to be fully understood.

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Antimicrobial Treatment of Pseudomonas aeruginosa Severe Sepsis

Cited by 20 publications

References 156 publications

Association between combination antibiotic therapy as opposed as monotherapy and outcomes of ICU patients with Pseudomonas aeruginosa ventilator-associated pneumonia: an ancillary study of the iDIAPASON trial

Association between combination antibiotic therapy as opposed as monotherapy and outcomes of ICU patients with Pseudomonas aeruginosa ventilator-associated pneumonia: an ancillary study of the iDIAPASON trial

Community-acquired skin and soft-tissue infections in people who inject drugs

Infective Endocarditis after Transcatheter Aortic Valve Replacement: Challenges in the Diagnosis and Management

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