Outcomes of adult patients in the intensive care unit withPseudomonasaeruginosapneumonia who received an active anti‐pseudomonal β‐lactam: Does 'S' equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?
| Autor: | Theresa M. Im, Thomas P. Lodise, Lie H. Chen, Yun Tian, Sara Y. Tartof, Laura A Puzniak, Rong Wei |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty Cefepime beta‐lactams outcomes medicine.disease_cause Meropenem antibiotics law.invention resistance law Original Research Articles Internal medicine Pneumonia Bacterial medicine Humans Pharmacology (medical) Original Research Article Retrospective Studies treatment business.industry Pseudomonas aeruginosa Bacterial pneumonia Retrospective cohort study Odds ratio medicine.disease Intensive care unit pseudomonas Anti-Bacterial Agents Intensive Care Units Pneumonia Treatment Outcome epidemiology beta-Lactamase Inhibitors business medicine.drug |
| Zdroj: | Pharmacotherapy |
| ISSN: | 1875-9114 0277-0008 |
| DOI: | 10.1002/phar.2600 |
| Popis: | Study objectives The most commonly prescribed antibiotics for patients with hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) due to Pseudomonas aeruginosa are the conventional anti-pseudomonal β-lactams (APBLs) (ie, ceftazidime, cefepime, meropenem, or piperacillin-tazobactam). Similar resistance mechanisms in P. aeruginosa affect the APBLs, and it is unclear if resistance to one APBL can affect the effectiveness of other APBLs. This exploratory, hypothesis-generating analysis evaluates the impact of APBL resistance among patients in the intensive care unit (ICU) with P. aeruginosa HABP/VABP who initially receive a microbiologically active APBL. Design A retrospective cohort [GJ1] [LT2] study. Setting Kaiser Permanente Southern California members (01/01/2011-12/31/2017). Patients The study included adult patients admitted to the ICU with a monomicrobial P. aeruginosa HABP/VABP who received a microbiologically active APBL within 2 days of index P. aeruginosa respiratory culture. Intervention Patients were stratified by presence of resistance to APBL on index P. aeruginosa (0 vs. ≥1 resistant APBL). Measurements Primary outcomes were 30-day mortality and discharge to home. Main results Overall, 553 patients were included. Thirty-day mortality was 28%, and 32% of patients were discharged home. Eighty-eight patients (16%) had a P. aeruginosa HABP/VABP that was resistant to ≥1 APBL (other than active empiric treatment). Relative to patients with no APBL resistance, patients with resistance to ≥1 APBL had a higher 30-day mortality (adjusted odds ratio (aOR) [95% confidence interval (CI)]: 1.65 [1.02-2.66]) and were less likely to be discharged home (adjusted hazard ratio (aHR) [95% CI]: 0.50 [0.29-0.85]). Conclusion Further study is needed, but this exploratory analysis suggests that the full APBL susceptibility profile should be considered when selecting therapy for patients with P. aeruginosa HABP/VABP. |
| Databáze: | OpenAIRE |
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