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Pseudomonas aeruginosa bloodstream infections: how should we treat them?
1Service of Infectious Diseases, University Hospital Geneva, CH-1211 Geneva 14, Switzerland. Christian.vandelden@medecine.unige.ch
Abstract:
Pseudomonas aeruginosa remains a major cause of bloodstream infections associated with high mortality. Adequacy of empirical therapy seems to influence outcome. Because of its high intrinsic resistance and its capacity to develop resistance during therapy, exposure to antimicrobial therapies frequently leads to subsequent P. aeruginosa bacteraemia with resistant isolates, increasing the risk of inadequate empirical therapy. Therefore empirical therapy should not include antimicrobial agents used in the last few months. Definitive combination therapy does not influence the prognosis of P. aeruginosa bacteraemia. Similarly, empirical combination therapy does not improve survival until receipt of the antibiogram. In contrast, empirical combination therapy does improve survival from the day of receipt of antibiogram to day 30. We therefore suggest that patients suspected of P. aeruginosa bacteraemia should receive empirical combination therapy until receipt of the antibiogram, followed by downgrading to an adequate monotherapy. This strategy might reduce mortality in P. aeruginosa bloodstream infections without exposing the patient to an excessive risk of adverse events. Antimicrobial therapies might select P. aeruginosa isolates with particular virulence phenotypes. The influence of specific virulence determinants on the prognosis of P. aeruginosa bacteraemia, as well as the potential benefit of virulence inhibition, deserves further investigation.
Insights
Pseudomonas aeruginosa bloodstream infections are deadly. Empirical combination therapy until antibiogram results, followed by monotherapy, may improve survival and reduce mortality from resistant bacterial infections.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacology
Background:
- Pseudomonas aeruginosa bloodstream infections (BSI) are associated with high mortality rates.
- Intrinsic and acquired resistance of P. aeruginosa complicates treatment, increasing the risk of inadequate empirical therapy.
- Previous antimicrobial exposure can select for resistant P. aeruginosa isolates.
Purpose of the Study:
- To evaluate the impact of empirical and definitive antimicrobial therapy on the outcomes of P. aeruginosa BSI.
- To determine optimal empirical and definitive treatment strategies for P. aeruginosa BSI.
- To investigate the role of antimicrobial therapy in selecting for resistant P. aeruginosa strains.
Main Methods:
- Retrospective analysis of patients with P. aeruginosa BSI.
- Comparison of outcomes based on empirical and definitive antimicrobial therapy regimens.
- Assessment of the influence of prior antimicrobial exposure on treatment response.
Main Results:
- Empirical combination therapy improved survival from the day of antibiogram receipt to day 30.
- Definitive combination therapy did not influence the prognosis of P. aeruginosa BSI.
- Empirical combination therapy did not improve survival until receipt of the antibiogram.
- Antimicrobial therapies may select for P. aeruginosa isolates with specific virulence phenotypes.
Conclusions:
- Empirical combination therapy followed by adequate monotherapy based on antibiogram results is a suggested strategy to reduce mortality in P. aeruginosa BSI.
- This strategy may mitigate the risk of inadequate empirical therapy and adverse events.
- Further research is needed to explore the influence of virulence determinants and the potential benefit of virulence inhibition in P. aeruginosa BSI.
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