From the Guidelines
For patients with invasive infections caused by Pseudomonas aeruginosa with difficult-to-treat resistance, novel β-lactam agents such as ceftolozane/tazobactam and ceftazidime/avibactam are the first-line options for targeted treatment. This recommendation is based on the latest guidelines endorsed by the Italian Society of Infection and Tropical Diseases (SIMIT), the Italian Society of Anti-Infective Therapy (SITA), the Italian Group for Antimicrobial Stewardship (GISA), the Italian Association of Clinical Microbiologists (AMCLI), and the Italian Society of Microbiology (SIM) 1.
Key Considerations
- The strength of this recommendation is strong, with a moderate certainty of evidence 1.
- Alternative options for treatment include imipenem/cilastatin–relebactam, cefiderocol, and colistin-based therapy 1.
- It is crucial to note that Pseudomonas aeruginosa infections are challenging to treat due to the bacterium's natural resistance to many antibiotics, emphasizing the need for targeted and effective treatment strategies 1.
Treatment Approach
- The choice of antibiotic should be guided by susceptibility testing and local resistance patterns.
- Combination therapy may be considered for severe infections, but the primary approach should focus on the use of novel β-lactam agents as first-line treatment 1.
- Infection control measures are critical in preventing the spread of Pseudomonas aeruginosa in healthcare settings, given its ability to contaminate medical equipment and solutions 1.
From the Research
Pseudomonas Infections
- Pseudomonas aeruginosa is a nosocomial pathogen that can cause various infections, including pneumonia, bacteremia, and endocarditis 2.
- The treatment of P. aeruginosa infections is challenging due to the limited choices of antibiotics and the emergence of resistance 3, 2.
Antibiotic Treatment
- Conventional antipseudomonal antibiotics have been used successfully for a long time, but the increase in worldwide resistance necessitates the need for newer agents 3.
- Novel fluoroquinolones and new combinations of β-lactams/β-lactamase inhibitors have been studied and show promising results against P. aeruginosa 3.
- Cefiderocol, a new cephalosporin, shows very promising results against P. aeruginosa 3.
- Ceftazidime, carbapenems, and piperacillin-tazobactam can be used as single definitive therapy for P. aeruginosa bloodstream infection, with no significant difference in mortality, clinical, and microbiological outcomes or adverse events 4.
Therapeutic Approaches
- Therapeutic guidelines for P. aeruginosa infections should be based on continuous resistance surveillance, in vitro synergistic interactions of antibacterial agents, pharmacodynamic properties of antibiotics, and current information on the necessity for combination therapy 2.
- Bacteriophage therapy is a growing field of interest and may have an impactful effect on the treatment of resistant P. aeruginosa 3.
- Novel therapeutic approaches, including conventional therapy, novel antibiotic treatments, and treatments other than antibiotics, are being developed to combat P. aeruginosa infections 5.