From the Guidelines
Pseudomonas aeruginosa infection should be treated with novel β-lactam agents such as ceftolozane/tazobactam and ceftazidime/avibactam as first-line options.
Treatment Options
- Ceftolozane/tazobactam and ceftazidime/avibactam are recommended as first-line options for targeted treatment of invasive infections caused by Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-PA) 1.
- Imipenem/cilastatin–relebactam and cefiderocol might be potential alternatives, as well as colistin-based therapy 1.
- For patients with hospital-acquired and ventilator-associated pneumonia (HAP/VAP) due to P. aeruginosa, the choice of an antibiotic for definitive therapy should be based upon the results of antimicrobial susceptibility testing 1.
- In patients with chronic P. aeruginosa infection, inhaled colistin is recommended, with inhaled gentamicin as a second-line alternative 1.
Key Considerations
- The selection of an antibiotic should depend on factors such as the severity of the infection, local pattern of resistances, tolerability, cost, and potential compliance 1.
- Combination therapy may be considered in certain cases, such as in patients with repeated infections despite other treatments 1.
- It is essential to review the patient’s culture and mycobacterial status, optimize airway clearance, and treat other associated conditions before starting long-term antibiotics 1.
From the Research
Antibiotic Treatment for Pseudomonas aeruginosa Infection
The treatment of Pseudomonas aeruginosa infections is challenging due to the limited choices of antibiotics and the emergent resistance of the pathogen 2. Several antibiotic options are available, including:
- Novel fluoroquinolones, which have been recently introduced and show favorable activity 2
- New combinations of β-lactams/β-lactamase inhibitors, which have been studied in various indications of infections because of P. aeruginosa 2
- Cefiderocol, a new cephalosporin, which shows very promising results against P. aeruginosa 2, 3, 4
- Ceftolozane-tazobactam and ceftazidime-avibactam, which are useful against difficult-to-treat P. aeruginosa (DTR-PA) strains 3, 4
- Imipenem-relebactam, which is effective against DTR-PA strains 3
- Aztreonam-ceftazidime-avibactam, which may be effective for carbapenemase producers 3
- Colistin, which may be effective for carbapenemase producers 3
Factors Guiding Clinical Decisions
Clinical decisions for empiric and directed P. aeruginosa therapy are guided by several factors, including:
- Epidemiology 2, 4
- Patient's risk factors 2, 5
- Site of infection 2, 3
- Available treatment options 2, 3, 4, 6, 5
Combination Therapy
Combination therapy is only recommended in limited scenarios 2, and may be necessary for empirical treatment 3. However, combination therapy may pose an increased risk of antibiotic toxicity and secondary infection 5.
Alternative Therapies
Alternative therapies, such as bacteriophage therapy, are being explored for the treatment of resistant P. aeruginosa infections 2, 5. Bacteriophages represent a promising candidate for combatting recurrent and refractory infections with their ability to target specific host bacteria and circumvent traditional mechanisms of antibiotic resistance seen in MDR/XDR-P. aeruginosa 5.