Osteoarticular infection caused by MDR Pseudomonas aeruginosa: the benefits of combination therapy with colistin plus β-lactams
| Autor: | Jaime Lora-Tamayo, Javier Ariza, Xavier de Cabo, Salvador Pedrero, Oscar Murillo, Fe Tubau, Eva Benavent, Alba Ribera |
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| Rok vydání: | 2015 |
| Předmět: |
Microbiology (medical)
Male medicine.medical_specialty Prosthesis-Related Infections Combination therapy medicine.drug_class Antibiotics Drug resistance medicine.disease_cause beta-Lactams Pharmacotherapy Internal medicine Drug Resistance Multiple Bacterial Osteoarthritis medicine Combined Modality Therapy Humans Pharmacology (medical) Pseudomonas Infections Prospective Studies Aged Retrospective Studies Pharmacology Pseudomonas aeruginosa business.industry Colistin Retrospective cohort study Middle Aged Surgery Anti-Bacterial Agents Infectious Diseases Treatment Outcome Drug Therapy Combination Female business medicine.drug |
| Zdroj: | The Journal of antimicrobial chemotherapy. 70(12) |
| ISSN: | 1460-2091 |
| Popis: | Objectives In the era of emergence of MDR Pseudomonas aeruginosa, osteoarticular infections (OIs) add more difficulties to its treatment. The role of β-lactams (BLs) is questioned and older drugs need to be reconsidered. The objective of this study was to describe our experience in the management of OIs caused by MDR P. aeruginosa and evaluate different therapeutic options. Methods This was a retrospective analysis of a prospectively collected cohort (2004-13) of patients with OI caused by MDR P. aeruginosa. We created two groups: (i) Group A (more difficult to treat), prosthetic joint infections (PJIs) and osteoarthritis (OA) managed with device retention; and (ii) Group B (less difficult to treat), OA managed without device retention. Antibiotic treatment was administered according to clinician criteria: monotherapy/combined therapy; and BL used by intermittent bolus (IB)/continuous infusion. Results Of 34 patients, 15 (44.1%) had PJI and 19 (55.9%) had OA (8 related to an orthopaedic device). Twenty-three cases (68%) were caused by XDR P. aeruginosa. The initial management included removal of an orthopaedic device in 14 cases, together with antibiotic [alone, 19 (55.9%; 4 colistin, 14 BL-IB and 1 BL continuous infusion); and in combination, 15 (44.1%; 5 BL-IB and 10 BL continuous infusion)]. The overall cure rate was 50% (39% and 63% in Groups A and B, respectively), ranging from 31.6% with monotherapy to 73.3% with combined therapy (P = 0.016), with special interest within Group A (cure rate with combined therapy 71.4%, P = 0.049). After rescue therapy, which included removal of remaining devices, the cure rate reached 85.3%. Conclusions We suggest that the BL/colistin combination is an optimized therapy for OI caused by MDR P. aeruginosa, together with an appropriate surgical treatment. |
| Databáze: | OpenAIRE |
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