Management of multidrug-resistant Pseudomonas aeruginosa in the intensive care unit: state of the art.
Alberto Enrico MaraoloMarco CascellaSilvia CorcioneArturo CuomoSalvatore NappaGuglielmo BorgiaFrancesco Giuseppe De RosaIvan GentilePublished in: Expert review of anti-infective therapy (2017)
Pseudomonas aeruginosa (PA) is one of the most important causes of healthcare-related infections among Gram-negative bacteria. The best therapeutic approach is controversial, especially for multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains as well as in the setting of most severe patients, such as in the intensive care unit (ICU). Areas covered: This article addresses several points. First, the main microbiological aspects of PA, focusing on its wide array of resistance mechanisms. Second, risk factors and the worse outcome linked to MDR-PA infection. Third, the pharmacological peculiarity of ICU patients, that makes the choice of a proper antimicrobial therapy difficult. Eventually, the current therapeutic options against MDR-PA are reviewed, taking into account the main variables that drive antimicrobial optimization in critically ill patients. Literature search was carried out using Pubmed and Web of Science. Expert commentary: Methodologically rigorous studies are urgently needed to clarify crucial aspects of the treatment against MDR-PA, namely monotherapy versus combination therapy in empiric and targeted settings. In the meanwhile, useful options are represented by newly approved drugs, such as ceftolozane/tazobactam and ceftazidime/avibactam. In critically ill patients, at least as empirical approach, a combination therapy is a prudent choice when a MDR-PA strain is suspected.
Keyphrases
- multidrug resistant
- drug resistant
- gram negative
- combination therapy
- acinetobacter baumannii
- klebsiella pneumoniae
- pseudomonas aeruginosa
- end stage renal disease
- healthcare
- ejection fraction
- chronic kidney disease
- newly diagnosed
- cystic fibrosis
- risk factors
- staphylococcus aureus
- prognostic factors
- systematic review
- intensive care unit
- public health
- high throughput
- mechanical ventilation
- pulmonary embolism
- biofilm formation
- randomized controlled trial
- clinical trial
- open label
- patient reported outcomes
- high density
- decision making
- drug induced
- cell therapy
- affordable care act