Hostname: page-component-7c8c6479df-hgkh8 Total loading time: 0 Render date: 2024-03-19T05:58:42.526Z Has data issue: false hasContentIssue false

Identification of Optimal Combinations for Empirical Dual Antimicrobial Therapy of Pseudomonas aeruginosa Infection: Potential Role of a Combination Antibiogram

Published online by Cambridge University Press:  21 June 2016

Mari Mizuta
Affiliation:
Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Darren R. Linkin
Affiliation:
Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Mark G. Weiner
Affiliation:
Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Angela Sheridan
Affiliation:
Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ebbing Lautenbach*
Affiliation:
Division of Infectious Diseases, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021 (elautenb@mail.med.upenn.edu)

Abstract

To better determine the optimal combinations for empirical dual antimicrobial therapy of Pseudomonas aeruginosa infection, we evaluated the utility of a novel combination antibiogram. Although the combination antibiogram allowed modest fine-tuning of choices for dual antibiotic therapy, selections based on the 2 antibiograms did not differ substantively. Drug combinations with the broadest coverage were consistently composed of an aminoglycoside and a β-lactam.

Type
Concise Communications
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Cohen, ML. Epidemiology of drug resistance: implications for a post-antimicrobial era. Science 1992; 257:10501055.CrossRefGoogle ScholarPubMed
2.Holmberg, SD, Solomon, SL, Blake, PA. Health and economic impacts of antimicrobial resistance. Rev Infect Dis 1987; 9:10651078.Google Scholar
3.Leibovici, L, Shraga, I, Drucker, M, Konigsberger, H, Samra, Z, Pitlik, SD. The benefit of appropriate empirical antibiotic treatment in patients with bloodstream infection. J Intern Med 1998; 244:379386.CrossRefGoogle ScholarPubMed
4.Weinstein, MP, Towns, ML, Quartey, SM, et al. The clinical significance of positive blood cultures in the 1990s: a prospective comprehensive evaluation of the microbiology, epidemiology, and outcome of bacteremia and fungemia in adults. Clin Infect Dis 1997; 24:584602.CrossRefGoogle ScholarPubMed
5.Ibrahim, EH, Sherman, G, Ward, S, Fraser, VJ, Kollef, MH. The influence of inadequate antimicrobial treatment of bloodstream infection on patient outcome in the ICU setting. Chest 2000; 118:146155.CrossRefGoogle ScholarPubMed
6.Alvarez-Lerna, F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit: ICU-Acquired Pneumonia Study Group. Intensive Care Med 1996; 22:387394.Google Scholar
7.National Committee for Clinical Laboratory Standards (NCCLS). Abbreviated Identification of Bacteria and Yeast; Approved Guideline. Wayne, PA: NCCLS; 2002. NCCLS document M35-A.Google Scholar
8.National Committee for Clinical Laboratory Standards (NCCLS). Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: NCCLS; 2001. NCCLS approved standard M100-S11.Google Scholar
9.Ernst, EJ, Diekema, DJ, BootsMiller, BJ, et al. Are United States hospitals following national guideline for the analysis and presentation of cumulative antimicrobial susceptibility data? Diagn Microbiol Infect Dis 2004; 49:141145.CrossRefGoogle ScholarPubMed
10.Takigawa, K, Fujita, J, Negayama, K, et al. Comparing antimicrobial activity against resistant Pseudomonas aeruginosa using an index for the absence of cross-resistance. J Antimicrob Chemother 1995; 35:425427.Google Scholar
11.Bouza, E, Garcia-Garrote, F, Cercenado, E, Martin, M, Diaz, MS, for the Spanish Pseudomonas aeruginosa Study Group. Pseudomonas aeruginosa; a survey of resistance in 136 hospitals in Spain. Antimicrob Agents Chemother 1999; 43:981982.Google Scholar
12.Bonfiglio, G, Carciotto, V, Russo, G, et al. Antibiotic resistance in Pseudomonas aeruginosa: an Italian study. J Antimicrob Chemother 1998; 41:307310.CrossRefGoogle Scholar
13.Friedland, I, Stinson, L, Ikaiddi, M, Harm, S, Woods, GL. Phenotypic antimicrobial resistance patterns in Pseudomonas aeruginosa and Acinetobacter: results of a multicenter intensive care unit surveillance study, 1995-2000. Diagn Microbiol Infect Dis 2003; 45:245250.Google Scholar
14.Young, LS. Sepsis syndrome. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000:806819.Google Scholar
15.Flamm, RK, Weaver, MK, Thornsberry, C, Jones, ME, Karlowsky, JA, Sahm, DF. Factors associated with relative rates of antibiotic resistance in Pseudomonas aeruginosa isolates in clinical laboratories in the United States from 1999 to 2002. Antimicrob Agents Chemother 2004; 48:24312436.Google Scholar
16.Fluit, AC, Verhoef, J, Schmitz, FJ. Antimicrobial resistance in European isolates of Pseudomonas aeruginosa. European Sentry Participants. Eur J Clin Microbiol Infect Dis 2000; 19:370374.Google Scholar
17.National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 2003; 31:481498.CrossRefGoogle Scholar