From the Guidelines
The management of Achromobacter pneumonia typically involves antibiotic therapy with broad-spectrum agents.
Recommended Treatment Options
- Ceftazidime 2 g IV every 8 hours, or
- Piperacillin-tazobactam 4.5 g IV every 6 hours, or
- Meropenem 1 g IV every 8 hours, or
- Imipenem 500 mg IV every 6 hours, as suggested by guidelines for hospital-acquired pneumonia 1.
Treatment Considerations
It is essential to obtain antimicrobial susceptibility testing to guide therapy, as Achromobacter species can exhibit resistance to multiple antibiotics.
Supportive Care
Additionally, supportive care, such as oxygen therapy and hydration, may be necessary to manage symptoms and prevent complications.
Duration of Treatment
Treatment duration is usually 10-14 days, but may be extended to 21 days in severe cases or in patients with underlying conditions. In cases where the patient is at high risk of mortality or has received intravenous antibiotics in the prior 90 days, a combination of antibiotics, including coverage for MRSA, may be necessary, as outlined in guidelines for hospital-acquired pneumonia 1.
From the FDA Drug Label
- 3 Hospital-acquired Bacterial Pneumonia and Ventilator-associated Bacterial Pneumonia (HABP/VABP) AVYCAZ (ceftazidime and avibactam) is indicated for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia (HABP/VABP) in adult and pediatric patients (at least 31 weeks gestational age) caused by the following susceptible gram-negative microorganisms: Klebsiella pneumoniae, Enterobacter cloacae, Escherichia coli, Serratia marcescens, Proteus mirabilis, Pseudomonas aeruginosa, and Haemophilus influenzae.
The management of Achromobacter pneumonia is not directly addressed in the provided drug label. However, the label does mention the treatment of Hospital-acquired Bacterial Pneumonia and Ventilator-associated Bacterial Pneumonia (HABP/VABP) caused by susceptible gram-negative microorganisms.
- Key points:
- The drug label does not explicitly mention Achromobacter as a susceptible microorganism.
- The label recommends using AVYCAZ for HABP/VABP caused by certain gram-negative microorganisms, but Achromobacter is not listed. Therefore, based on the provided information, no conclusion can be drawn about the management of Achromobacter pneumonia with AVYCAZ 2.
From the Research
Management of Achromobacter Pneumonia
The management of Achromobacter pneumonia is challenging due to the organism's inherent and acquired multidrug resistance patterns.
- The most commonly used definitive antibiotics for Achromobacter pneumonia are imipenem/cilastatin, cefepime, or trimethoprim/sulfamethoxazole 3.
- Among usual antimicrobial agents, imipenem (70% susceptibility) is the most active, followed by trimethoprim-sulfamethoxazole, piperacillin, and tigecycline (65%, 56%, and 52% susceptibility, respectively) 4.
- New therapeutic options, such as cefiderocol, appear to be promising for managing Achromobacter infections 4.
- Extended-spectrum penicillins and cephalosporins, such as ticarcillin, piperacillin, and cefoperazone, have also been shown to be effective in treating Achromobacter lung infections 5.
- Antipseudomonal penicillins and trimethoprim-sulfamethoxazole have been reported to inhibit most Achromobacter isolates, although multiple-drug resistance is common 6.
Treatment Outcomes
- Clinical success was achieved in 32 of 37 episodes (87%) of Achromobacter ventilator-associated pneumonia (VAP) in critically ill trauma patients 3.
- Microbiological success was seen in 21 of 28 episodes (75%) of Achromobacter VAP, and VAP-related mortality was 9% (3 of 34 patients) 3.
- Achromobacter lung infections have been reported to be difficult to treat, but respond well to extended-spectrum penicillins and cephalosporins 5.