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Outcomes of adult patients in the intensive care unit with Pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: Does “S” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?

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,...

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Autores principales: Lodise, Thomas P., Puzniak, Laura A., Chen, Lie H., Tian, Yun, Wei, Rong, Im, Theresa M., Tartof, Sara Y.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457199/
https://www.ncbi.nlm.nih.gov/pubmed/34097763
http://dx.doi.org/10.1002/phar.2600
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author Lodise, Thomas P.
Puzniak, Laura A.
Chen, Lie H.
Tian, Yun
Wei, Rong
Im, Theresa M.
Tartof, Sara Y.
author_facet Lodise, Thomas P.
Puzniak, Laura A.
Chen, Lie H.
Tian, Yun
Wei, Rong
Im, Theresa M.
Tartof, Sara Y.
author_sort Lodise, Thomas P.
collection PubMed
description 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.
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spelling pubmed-84571992021-09-28 Outcomes of adult patients in the intensive care unit with Pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: Does “S” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams? Lodise, Thomas P. Puzniak, Laura A. Chen, Lie H. Tian, Yun Wei, Rong Im, Theresa M. Tartof, Sara Y. Pharmacotherapy Original Research Articles 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. John Wiley and Sons Inc. 2021-07-05 2021-08 /pmc/articles/PMC8457199/ /pubmed/34097763 http://dx.doi.org/10.1002/phar.2600 Text en © 2021 The Authors. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy published by Wiley Periodicals LLC on behalf of Pharmacotherapy Publications, Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Research Articles
Lodise, Thomas P.
Puzniak, Laura A.
Chen, Lie H.
Tian, Yun
Wei, Rong
Im, Theresa M.
Tartof, Sara Y.
Outcomes of adult patients in the intensive care unit with Pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: Does “S” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?
title Outcomes of adult patients in the intensive care unit with Pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: Does “S” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?
title_full Outcomes of adult patients in the intensive care unit with Pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: Does “S” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?
title_fullStr Outcomes of adult patients in the intensive care unit with Pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: Does “S” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?
title_full_unstemmed Outcomes of adult patients in the intensive care unit with Pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: Does “S” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?
title_short Outcomes of adult patients in the intensive care unit with Pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: Does “S” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?
title_sort outcomes of adult patients in the intensive care unit with pseudomonas aeruginosa pneumonia who received an active anti‐pseudomonal β‐lactam: does “s” equal success in the presence of resistance to other anti‐pseudomonal β‐lactams?
topic Original Research Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8457199/
https://www.ncbi.nlm.nih.gov/pubmed/34097763
http://dx.doi.org/10.1002/phar.2600
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