A Combination Antibiogram Evaluation for Pseudomonas aeruginosa in Respiratory and Blood Sources from Intensive Care Unit (ICU) and Non-ICU Settings in US Hospitals
A Combination Antibiogram Evaluation for Pseudomonas aeruginosa in Respiratory and Blood Sources from Intensive Care Unit (ICU) and Non-ICU Settings in US Hospitals
复制标题
DOI：
10.1128/aac.02564-18
复制
发表时间：
2019-04-01
影响因子：
4.9
通讯作者：
Gupta, Vikas
中科院分区：
文献类型：
--
作者：
Puzniak, Laura;DePestel, Daryl D.;Gupta, Vikas
铜绿假单胞菌是一种重要的致病菌，具有很高的发病率和死亡率。美国医院获得性肺炎和呼吸机相关性肺炎的治疗指南建议高危患者使用两种抗肿瘤药物，以确保95%的患者接受积极的经验性治疗。我们评估了联合抗菌图谱在确定最佳抗P。铜绿假单胞菌药物治疗方案。我们对2016年10月1日至2017年9月30日期间从BD Insights Research数据库中的304家美国医院收集的所有非复制铜绿假单胞菌血液和呼吸道分离株的抗菌药敏感性进行了回顾性横断面分析。用联合抗生素图谱测定体外对潜在抗P-P的敏感性。铜绿假单胞菌联合方案由主干抗生素(超广谱头孢菌素、碳青霉烯或哌拉西林-他唑巴坦)和氨基糖苷类或氟喹诺酮组成。11,701株非重复铜绿假单胞菌对氟喹诺酮类药物的敏感率为72.7%，对哌拉西林-他唑巴坦的敏感率为85.0%。血液分离株的敏感率高于呼吸道分离株(P<；0.05)。抗生素组合导致敏感率增加，但没有达到95%抗生素覆盖率的目标。添加氨基糖苷的敏感率高于添加氟喹诺酮的敏感率，哌拉西林-他唑巴坦+氨基糖苷的敏感率最高(93.3%)。重症监护病房(ICU)分离株的敏感率普遍低于非ICU分离株。常用的抗铜绿假单胞菌药物，无论是单独使用还是联合使用，都不能达到美国医院铜绿假单胞菌分离株95%的覆盖率，这表明需要新的药物来实现这一目标。当地机构使用组合抗生素图谱有可能优化难以治疗的病原体引起的感染的经验治疗。
Pseudomonas aeruginosa is an important pathogen associated with significant morbidity and mortality. U.S. guidelines for the treatment of hospital-acquired and ventilator-associated pneumonia recommend the use of two antipseudomonal drugs for high-risk patients to ensure that >= 95% of patients receive active empirical therapy. We evaluated the utility of combination antibiograms in identifying optimal anti-P. aeruginosa drug regimens. We conducted a retrospective cross-sectional analysis of the antimicrobial susceptibility of all nonduplicate P. aeruginosa blood and respiratory isolates collected between 1 October 2016 and 30 September 2017 from 304 U.S. hospitals in the BD Insights Research Database. Combination antibiograms were used to determine in vitro rates of susceptibility to potential anti-P. aeruginosa combination regimens consisting of a backbone antibiotic (an extended-spectrum cephalosporin, carbapenem, or piperacillin-tazobactam) plus an aminoglycoside or fluoroquinolone. Single-agent susceptibility rates for the 11,701 nonduplicate P. aeruginosa isolates ranged from 72.7% for fluoroquinolones to 85.0% for piperacillin-tazobactam. Susceptibility rates were higher for blood isolates than for respiratory isolates (P < 0.05). Antibiotic combinations resulted in increased susceptibility rates but did not achieve the goal of 95% antibiotic coverage. Adding an aminoglycoside resulted in higher susceptibility rates than adding a fluoroquinolone; piperacillin-tazobactam plus an aminoglycoside resulted in the highest susceptibility rate (93.3%). Intensive care unit (ICU) isolates generally had lower susceptibility rates than non-ICU isolates. Commonly used antipseudomonal drugs, either alone or in combination, did not achieve 95% coverage against U.S. hospital P. aeruginosa isolates, suggesting that new drugs are needed to attain this goal. Local institutional use of combination antibiograms has the potential to optimize empirical therapy of infections caused by difficult-to-treat pathogens.