JAC Advance Access originally published online on September 1, 2003
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Journal of Antimicrobial Chemotherapy (2003) 52, 668-674
© 2003 The British Society for Antimicrobial Chemotherapy
Treatment and outcome of Pseudomonas aeruginosa bacteraemia: an antibiotic pharmacodynamic analysis
Faculties of 1 Pharmacy and 2 Medicine, University of Manitoba; 3 Microbiology Laboratory, 4 Infectious Diseases, and 5 Pharmacy, St Boniface General Hospital, Winnipeg, MB, Canada
Received 10 March 2003; returned 29 May 2003; revised 3 June 2003; accepted 6 July 2003
Objectives: To conduct a retrospective study of antibiotic pharmacodynamics in the treatment of Pseudomonas aeruginosa bacteraemia, and to identify pharmacodynamic indices associated with clinical cure.
Methods: Cases of P. aeruginosa bacteraemia were identified, and information related to patient demographics, clinical status, antibiotic treatment and clinical outcome were documented. Anti-pseudomonal therapy was assessed, and concentration versus time profiles were constructed using measured levels for aminoglycosides, or population pharmacokinetic models for other antibiotics. P. aeruginosa isolates from all patients were retrieved and MICs for the anti-pseudomonal agents used to treat the episode of bacteraemia were determined. Patient- and treatment-related factors were tested for associations with clinical outcome using univariate and multivariate analyses.
Results: Fifty cases of P. aeruginosa bacteraemia were identified and 38 cases were included in the pharmacodynamic analysis. Eighty-seven percent of patients received an aminoglycoside or ciprofloxacin and 79% received piperacillin or ceftazidime. A majority of patients, 71%, were administered a combination of antibiotics. Treatment outcomes were documented as persistent infection in 21%, death within 2–30 days in 21% and clinical cure in 58% of cases. Peak/MIC (P = 0.001) and AUC24/MIC (P = 0.002) for aminoglycosides and ciprofloxacin were significant factors in univariate tests. Only peak/MIC was associated independently with treatment outcome (P = 0.017) in logistic regression analysis. The predicted probability of cure was 
90% when peak/MIC was at least 8.
Conclusion: Pharmacodynamic considerations including aggressive dosing with targeted peak/MICs for aminoglycosides and ciprofloxacin are strongly associated with clinical outcome and essential to the appropriate management of P. aeruginosa bacteraemia.
Keywords: pseudomonal, bloodstream infections, peak/MIC, AUC/MIC
* Correspondence address. Division of Clinical Sciences and Practice, Faculty of Pharmacy, University of Manitoba, Winnipeg, Manitoba, Canada R3T 2N2. Tel: +1-204-474-8414; Fax: +1-204-474-7617; E-mail: zelenits{at}ms.umanitoba.ca
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  A. P. MacGowan and on behalf of the BSAC Working Parties on Resistanc Clinical implications of antimicrobial resistance for therapy J. Antimicrob. Chemother., November 1, 2008; 62(suppl_2): ii105 - ii114. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. Hocquet, A. Muller, K. Blanc, P. Plesiat, D. Talon, D. L. Monnet, and X. Bertrand Relationship between Antibiotic Use and Incidence of MexXY-OprM Overproducers among Clinical Isolates of Pseudomonas aeruginosa Antimicrob. Agents Chemother., March 1, 2008; 52(3): 1173 - 1175. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Turnidge and D. L. Paterson Setting and Revising Antibacterial Susceptibility Breakpoints Clin. Microbiol. Rev., July 1, 2007; 20(3): 391 - 408. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 O. H. Kamel Mohamed, I. M. Wahba, S. Watnick, S. B. Earle, W. M. Bennett, J. W. Ayres, and M. Y. Munar Administration of Tobramycin in the Beginning of the Hemodialysis Session: A Novel Intradialytic Dosing Regimen Clin. J. Am. Soc. Nephrol., July 1, 2007; 2(4): 694 - 699. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. H. Kiser, D. W. Hoody, M. D. Obritsch, C. O. Wegzyn, P. C. Bauling, and D. N. Fish Levofloxacin pharmacokinetics and pharmacodynamics in patients with severe burn injury. Antimicrob. Agents Chemother., June 1, 2006; 50(6): 1937 - 1945. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Golestaneh, J. Laut, S. Rosenberg, M. Zhang, and M. H. Mokrzycki Favourable outcomes in episodes of Pseudomonas bacteraemia when associated with tunnelled cuffed catheters (TCCs) in chronic haemodialysis patients Nephrol. Dial. Transplant., May 1, 2006; 21(5): 1328 - 1333. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Zelenitsky, R. Ariano, G. Harding, and A. Forrest Evaluating Ciprofloxacin Dosing for Pseudomonas aeruginosa Infection by Using Clinical Outcome-Based Monte Carlo Simulations Antimicrob. Agents Chemother., October 1, 2005; 49(10): 4009 - 4014. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Dupont, D. Hocquet, K. Jeannot, P. Chavanet, and P. Plesiat Bacteriostatic and bactericidal activities of eight fluoroquinolones against MexAB-OprM-overproducing clinical strains of Pseudomonas aeruginosa J. Antimicrob. Chemother., April 1, 2005; 55(4): 518 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Strijack, G. K. M. Harding, R. E. Ariano, and S. A. Zelenitsky Peritoneal Fluid Titer Test for Peritoneal Dialysis-Related Peritonitis Antimicrob. Agents Chemother., May 1, 2004; 48(5): 1719 - 1726. [Abstract] [Full Text] [PDF]
|
|