Study the use of beta-lactam monotherapy in bacteremia caused by Pseudomonas aeruginosa

IDIVAL researchers belonging to the group of Epidemiology and Pathogenic and Molecular Mechanisms of Infectious Diseases and Microbiology led by Dr. Carmen Fariñas, head of the Infectious Service of the Marqués de Valdecilla Hospital have participated in a study recently published in the journal Clinical Infectious Diseases.

This is a multinational and multicenter study in which data were collected from 25 centers in 9 countries in Europe, Australia and Israel, the largest to date comparing several beta-lactam monotherapies for the definitive treatment of Pseudomonas aeruginosa bacteremia, with 767 patients included.

P. aeruginosa bacteraemia accounts for 2-4% of bloodstream infections acquired in the hospital and is associated with high mortality rates, ranging from 20 to 40% at 30 days.

The optimal antibiotic regimen for P. aeruginosa bacteremia is controversial. Although monotherapy with beta-lactams is common, data to guide the choice between antibiotics are scarce. The objective of this study was to compare the use of ceftazidime, carbapenems and piperacillin-tazobactam as definitive monotherapy.

In this study, no significant differences were found between the three beta-lactam antibiotics used as monotherapy for the treatment of P. aeruginosa bacteremia in terms of mortality, clinical failure, microbiological failure or adverse events.

The detection of higher isolation rates of P. aeruginosa strains with new resistance profiles after treatment with carbapenems allows us to suggest a preference for ceftazidime or piperacillin-tazobactam for the treatment of bacteremia due to P. aeruginosa once the microorganism is detected and That is sensitive.

The importance of this study is given by the information it provides regarding the final clinical outcome of these infections that is similar with the use of specific anti-Pseudomonas antibiotics with that of very broad spectrum antibiotics. According to these data, antibiotics of a wider spectrum can be preserved in these cases, which may contribute to a decrease in the occurrence of resistance.

Reference: Babich T, Naucler P, Valik JK, Giske CG, Benito N, Cardona R, Rivera A, Pulcini C, Abdel Fattah M, Haquin J, Macgowan A, Grier S, Gibbs J, Chazan B, Yanovskay A, Ben Ami R, Landes M, Nesher L, Zaidman-Shimshovitz A, McCarthy K, Paterson DL, Tacconelli E, Buhl M, Mauer S, Bano JR, Morales I, Oliver A, Ruiz de Gopegui E, Cano A, Machuca I, Gozalo- Marguello M, Martinez LM, Gonzalez-Barbera EM, Alfaro IG, Salavert M, Beovic B, Saje A, Mueller-Premru M, Pagani L, Vitrat V, Kofteridis D, Zacharioudaki M, Maraki S, Weissman Y, Paul M, Dickstein And, Leibovici L, Yahav D. Ceftazidime, carbapenems, or piperacillin-tazobactam as single definitive therapy for Pseudomonas aeruginosa bloodstream infection – a multi-site retrospective study. Clin Infect Dis. 2019 Jul 17. pii: ciz668. doi: 10.1093 / cid / ciz668.