scholarly journals Ceftolozane/Tazobactam Versus Colistin in the Treatment of Ventilator-Associated Pneumonia Due to Extensively Drug-Resistant Pseudomonas Aeruginosa: A Comparative Cohort Study.

2021 ◽  
Author(s):  
Bence Mogyoródi ◽  
András B Csékó ◽  
Csaba Hermann ◽  
János Gál ◽  
Zsolt D Iványi
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Clinical Success ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Multivariate Regression Analysis ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Success Rates ◽  
Extensively Drug Resistant ◽  
All Cause Mortality

Abstract Background: Pseudomonas aeruginosa is a common pathogen in the intensive care unit (ICU). Resistant strains are frequently isolated, leaving colistimethate sodium (CMS), the drug with known toxicity and questionable pharmacokinetics, as the last-line conventional therapeutic option.The new cephalosporin and β-lactamase inhibitor combinations like ceftolozane/tazobactam (C/T) expanded the available antibiotics for Gram-negative infections. We aimed to compare C/T with CMS in the treatment of ventilator-associated pneumonia (VAP) due to extensively drug-resistant (XDR) Pseudomonas aeruginosa. Methods: A retrospective, observational study was performed at a tertiary care ICU. Patients with VAP due to XDR Pseudomonas aeruginosa were enrolled. Clinical and microbiological success rate, 28-day all-cause mortality, and adverse events were compared in patients who received C/T with those treated with systemic CMS. Multivariate logistic regression was performed to identify predictors of clinical success. Results: A total of 51 patients were included in the study (18 in the C/T and 33 in the CMS group). The represented population was acutely and chronically severely ill with a median Acute Physiology and Chronic Health Evaluation II score of 26 (interquartile range [IQR] 20-31) and a median Charlson Comorbidity Index of 4 (IQR 3-6) without statistical significant intergroup difference. Clinical success rates in the C/T and CMS groups were 13 (72.2 %) and 10 (30.3 %), respectively. On multivariate regression analysis, treatment with ceftolozane/tazobactam was independently associated with clinical success (odds ratio 4.47, 95% CI = 1.17-17.08). There was no difference in 28-day all-cause mortality (27.8 % and 33.3 % in the C/T and CMS group, p = 0.76). Acute kidney injury was more common in patients who received CMS (48.5 % vs 11.1 %, p = 0.01). There was a tendency for lower incidence of Clostridioides difficile colitis in the C/T compared to the CMS group (0 vs 9.1%). Conclusions: Ceftolozane/tazobactam proved to be efficient in the treatment of XDR Pseudomonas aeruginosa VAP and showed a better safety profile compared to CMS. Trial registration: Retrospectively registered with ClinicalTrials.gov (identifier NCT04352855).

scholarly journals Ceftolozane/tazobactam versus colistin in the treatment of ventilator-associated pneumonia due to extensively drug-resistant Pseudomonas aeruginosa: a comparative cohort study

2021 ◽  
Author(s):  
Bence Mogyoródi ◽  
András Csékó ◽  
Csaba Hermann ◽  
János Gál ◽  
Zsolt Iványi
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Clinical Success ◽  
Tertiary Care ◽  
Kidney Injury ◽  
Multivariate Regression Analysis ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Success Rates ◽  
Extensively Drug Resistant ◽  
All Cause Mortality

Abstract Background Resistant strains of Pseudomonas aeruginosa are common pathogens in the intensive care unit (ICU), limiting available therapeutic options. We aimed to compare ceftolozane/tazobactam (C/T) with colistimethate sodium (CMS) in the treatment of ventilator-associated pneumonia (VAP) due to extensively drug-resistant (XDR) Pseudomonas aeruginosa. Methods A retrospective, observational study was performed at a tertiary care ICU. Clinical and microbiological success rate, 28-day all-cause mortality, and adverse events were compared in patients who received C/T with those treated with systemic CMS. Results A total of 51 patients were included (18 in the C/T and 33 in the CMS group). Clinical success rates in the C/T and CMS groups were 13 (72.2 %) and 10 (30.3 %), respectively. On multivariate regression analysis, treatment with C/T was independently associated with clinical success (odds ratio 4.47, 95% CI = 1.17–17.08). There was no difference in 28-day all-cause mortality (27.8 % and 33.3 % in the C/T and CMS group, p = 0.76). Acute kidney injury was more common in patients who received CMS (48.5 % vs 11.1 %, p = 0.01). Conclusions Ceftolozane/tazobactam proved to be efficient in the treatment of XDR Pseudomonas aeruginosa VAP and showed a better safety profile compared to CMS.

scholarly journals Complete Genome Sequences of Four Extensively Drug-Resistant Pseudomonas aeruginosa Strains, Isolated from Adults with Ventilator-Associated Pneumonia at a Tertiary Referral Hospital in Mexico City

2017 ◽  
Vol 5 (36) ◽  
Author(s):  
Luis F. Espinosa-Camacho ◽  
Gabriela Delgado ◽  
Gloria Soberón-Chávez ◽  
Luis D. Alcaraz ◽  
Jorge Castañon ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Single Molecule ◽  
Genomic Islands ◽  
Ventilator Associated Pneumonia ◽  
Drug Resistant ◽  
Tertiary Referral Hospital ◽  
Content Type ◽  
Pacbio Rs Ii ◽  
Extensively Drug Resistant ◽  
Class 1

ABSTRACT Four extensively drug-resistant Pseudomonas aeruginosa strains, isolated from patients with pneumonia, were sequenced using PacBio RS-II single-molecule real-time (SMRT) technology. Genome sequence analysis identified great variability among mobile genetic elements, as well as some previously undescribed genomic islands and new variants of class 1 integrons (In1402, In1403, In1404, and In1408).

scholarly journals Antimicrobial Agents Administration among Patients with Extensively Drug-resistant Pseudomonas aeruginosa Infection in Intensive Care Unit in Tertiary Care: A Hospital-based Study

2020 ◽  
Author(s):  
Somkiattiyos Woradet ◽  
Bhunyabhadh Chaimay ◽  
Nuntiput Putthanachot ◽  
Narongchai Sangsa ◽  
Phatsaraporn Sirisa
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Antimicrobial Agent ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Introduction: Infections caused by Extensively Drug-resistant Pseudomonas aeruginosa (XDR-PA) is a medical problem worldwide. In Thailand, the incidence of XDR-PA bacteremia remains and is continuously increasing.Aim: To investigate an association between antimicrobial agent administration and the treatment of XDR-PA infection among patients admitted in Intensive Care Unit (ICU). Materials and Methods: A hospital-based analytic cross-sectional study was performed from January 2014 to December 2015. Of these, 47 cases diagnosed with XDR-PA bacteremia infection and 94 controls without XDR-PA infection were enrolled. Data were retrieved and retrospectively reviewed from medical records of the patients hospitalised in the ICU at Roi-Et Hospital, Thailand. Multiple logistic regressions were used and perform to investigate an association between antimicrobial agent administrations for treatment of XDR-PA infection. Results: Third generation Cephalosporin (OR=1.99; 95%CI: 1.22 to 4.13), Ciprofloxacin (OR=3.40; 95%CI: 1.24 to 9.49) and Carbapenem (OR=4.66; 95%CI: 2.04 to 10.64) were more likely to be administrated for treatment of XDR-PA infection among patients. Conclusion: Antimicrobial agents associated with the treatment of XDR-PA bacteremia infection among patients were third generation Cephalosporin, Ciprofloxacin and Carbapenem.

scholarly journals 1597. Ceftolozane-Tazobactam and Meropenem Synergy Testing Against Multi-Drug and Extensively-Drug Resistant Pseudomonas aeruginosa

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S794-S795
Author(s):  
Mary Francine P Chua ◽  
Syeda Sara Nida ◽  
Jerry Lawhorn ◽  
Janak Koirala
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Synergistic Effect ◽  
Inhibitory Concentration ◽  
Multidrug Resistant ◽  
Additive Effect ◽  
Teaching Hospitals ◽  
Drug Resistant ◽  
Extensively Drug Resistant ◽  
Synergy Testing ◽  
Concentration Indices

Abstract Background Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa (PA) have limited therapeutic options for treatment. Ceftolozane/tazobactam is a newer anti-pseudomonal drug effective against resistant PA infections, however resistance against this drug has now also developed and is increasing. In this study, we explored the combination of ceftolozane/tazobactam (CT) and meropenem (MP) as a possible effective regimen against MDR and XDR PA. Methods We obtained 33 non-duplicate isolates of MDR and XDR PA grown from blood, urine and respiratory samples collected from patients admitted between 2015 and 2019 at our two affiliate teaching hospitals. MDR PA was defined as resistance to 3 or more classes of anti-pseudomonal antibiotics, and XDR PA as resistance to all but two or less classes of anti-pseudomonal antibiotics. Antimicrobial preparations of both MP and CT were made according to manufacturer instructions. Susceptibility testing was performed using the checkerboard method in accordance to CLSI guidelines (CLSI M100, 2017). The ATCC 27853 strain of PA used as control. Synergy, additive effect, indifference and antagonism were defined as FIC (fractional inhibitory concentration) indices of ≤0.5, >0.5 to <1, >1 to <4, and >4, respectively. Results Thirteen (39%) of 33 PA isolates were classified as XDR, while 20 (61%) PA isolates were MDR. All isolates were resistant to MP (MIC50 >32 ug/mL), while only 2 (6%) isolates were susceptible to CT (MIC50 64 ug/mL). A synergistic effect was seen in 9 (27.3%) of PA isolates (FIC index range 0.28 to 0.5)— 2 of which were XDR PA, and 7 were MDR PA. An additive effect was seen in 12 (36.4%), with indifference seen in 12 (36.4%) of isolates. In this study, no antagonism was seen when CT and MP were combined. Conclusion When used in combination, CT and MP can exert a synergistic effect against MDR and XDR PA. Additive effect and indifference can also be seen when both antibiotics were used. Moreover, there was no antagonism seen when both antibiotics were combined. This study shows that the use of CT and MP in combination may be an option against XDR and MDR PA infections. Disclosures All Authors: No reported disclosures

scholarly journals Genomic analysis of an extensively drug-resistant Pseudomonas aeruginosa ST312 harbouring IncU plasmid-mediated blaKPC-2 isolated from ascitic fluid

2021 ◽  
Vol 25 ◽  
pp. 151-153
Author(s):  
Daniela Cristina Tartari ◽  
Caetana Paes Zamparette ◽  
Graciele Martini ◽  
Sandra Christakis ◽  
Luiz Henrique Costa ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Ascitic Fluid ◽  
Genomic Analysis ◽  
Drug Resistant ◽  
Extensively Drug Resistant
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