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Microorganisms. 2018 Jan 16;6(1). pii: E9. doi: 10.3390/microorganisms6010009.

Therapeutic Management of Pseudomonas aeruginosa Bloodstream Infection Non-Susceptible to Carbapenems but Susceptible to "Old" Cephalosporins and/or to Penicillins.

Author information

1
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel. ronitz@asaf.health.gov.il.
2
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel. ronitz@asaf.health.gov.il.
3
Intensive-Care Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel. asafmiller@gmail.com.
4
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel. ruthyanat@gmail.com.
5
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel. hadasofe@gmail.com.
6
Bioinformatics Unit, National Institute for Biotechnology in the Negev, Beer-Sheva 84105, Israel. Sklarz@bgu.ac.il.
7
Department of Internal Medicine, Shaare Zedek Medical Center, Hebrew-University, Hadassah Medical School, Jerusalem 91031, Israel. dekatz1@gmail.com.
8
Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin 70300, Israel. zlazarovitch@asaf.health.gov.il.
9
Department of University Laboratories, Detroit Medical Center, Detroit, MI 48201, USA. drlephart@gmail.com.
10
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel. bettytade@gmail.com.
11
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel. orantzuman@gmail.com.
12
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel. mord@asaf.health.gov.il.
13
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel. chendaniel77@gmail.com.
14
Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel. giladko@post.bgu.ac.il.
15
Public Health Services, Ministry of Health, Jerusalem 91010, Israel. giladko@post.bgu.ac.il.
16
ESCMID Study Group for Genomic and Molecular Diagnostics (ESGMD), 214 4010 Basel, Switzerland. giladko@post.bgu.ac.il.
17
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel. drormarchaim@gmail.com.
18
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel. drormarchaim@gmail.com.

Abstract

It is unknown as to whether other beta-lactams can be used for bloodstream infections (BSI) resulting from Pseudomonas aeruginosa (PA) which are non-susceptible to one or more carbapenem. We conducted a retrospective cohort study at the Assaf Harofeh Medical Center (AHMC) from January 2010 to August 2014. Adult patients with PA-BSI non-susceptible to a group 2 carbapenem but susceptible to ceftazidime or piperacillin (with or without tazobactam), were enrolled. We compared the outcomes of patients who received an appropriate beta-lactam antibiotic ("cases") to those who received an appropriate non-beta-lactam antibiotic ("controls"). Whole genome sequencing was performed for one of the isolates. Twenty-six patients with PA-BSI met inclusion criteria: 18 received a beta-lactam and 8 a non-beta-lactam (three a fluoroquinolone, two colistin, one a fluoroquinolone and an aminoglycoside, one a fluoroquinolone and colistin, and one colistin and an aminoglycoside). All clinical outcomes were similar between the groups. There were large variations in the phenotypic susceptibilities of the strains. A detailed molecular investigation of one isolate revealed a strain that belonged to MLST-137, with the presence of multiple efflux pumps, OXA-50, and a chromosomally mediated Pseudomonas-derived cephalosporinase (PDC). The oprD gene was intact. Non-carbapenem-β-lactams may still be effective alternatives for short duration therapy (up to 14 days) for BSI caused by a carbapenem non-susceptible (but susceptible to ceftazidime, piperacillin, and/or piperacillin-tazobactam) PA strain. This observation requires further confirmatory analyses. Future molecular investigations should be performed, in order to further analyze additional potential mechanisms for this prevalent phenotype.

KEYWORDS:

BSI; ICU; MDRO; gram-negative; non-fermenter; nosocomial infections

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