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JAC Advance Access published online on June 11, 2009
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkp201
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Review

Update on the treatment of Pseudomonas aeruginosa pneumonia

Ali A. El Solh1,2,3,* and Ahmad Alhajhusain1,2

1 Veterans Affairs Western New York Healthcare System, Buffalo, NY, USA 2 Western New York Respiratory Research Center, Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, State University of New York at Buffalo School of Medicine and Biomedical Sciences, Buffalo, NY, USA 3 Department of Social and Preventive Medicine, School of Public Health and Health Professions, Buffalo, NY, USA

* Corresponding author. Division of Pulmonary, Critical Care and Sleep Medicine, State University of New York at Buffalo, Veterans Affairs Western New York Healthcare System, 3495 Bailey Avenue, Buffalo, NY 14215-1199, USA. Tel: +1-716-862-8634; Fax +1-716-862-8632; E-mail: solh{at}buffalo.edu

Pseudomonas aeruginosa is an important cause of nosocomial pneumonia associated with a high morbidity and mortality rate. This bacterium expresses a variety of factors that confer resistance to a broad array of antimicrobial agents. Empirical antibiotic therapy is often inadequate because cultures from initial specimens grow strains that are resistant to initial antibiotics. Surveillance data, hospital antibiogram and individualization of regimens based on prior antibiotic use may reduce the risk of inadequate therapy. The use of combination therapies for P. aeruginosa pneumonia has been a long-advocated practice, but the potential increased value of combination therapy over monotherapy remains controversial. Doripenem and biapenem are new carbapenems that have excellent activity against P. aeruginosa; however, they lack activity against strains that express resistance to the currently available carbapenems. The polymyxins remain the most consistently effective agents against multidrug-resistant P. aeruginosa. Strains that are panantibiotic-resistant are rare, but their incidence is increasing. Antibiotic combinations that yield some degree of susceptibility in vitro are the recourse, although the efficacy of these regimens has yet to be established in clinical studies. Experimental polypeptides may provide a new therapeutic approach. Among these, the anti-PcrV immunoglobulin G antibody that blocks the type III secretion system-mediated virulence of P. aeruginosa has recently entered Phase I/II clinical trials.

Key Words: combination therapy , multidrug resistance , antimicrobials


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