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Microorganisms 2018, 6(1), 9; https://doi.org/10.3390/microorganisms6010009

Therapeutic Management of Pseudomonas aeruginosa Bloodstream Infection Non-Susceptible to Carbapenems but Susceptible to “Old” Cephalosporins and/or to Penicillins

1
Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel
2
Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel
3
Intensive-Care Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel
4
Bioinformatics Unit, National Institute for Biotechnology in the Negev, Beer-Sheva 84105, Israel
5
Department of Internal Medicine, Shaare Zedek Medical Center, Hebrew-University, Hadassah Medical School, Jerusalem 91031, Israel
6
Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin 70300, Israel
7
Department of University Laboratories, Detroit Medical Center, Detroit, MI 48201, USA
8
Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel
9
Public Health Services, Ministry of Health, Jerusalem 91010, Israel
10
ESCMID Study Group for Genomic and Molecular Diagnostics (ESGMD), 214 4010 Basel, Switzerland
Ronit Zaidenstein and Asaf Miller had contributed evenly to this publication.
*
Author to whom correspondence should be addressed.
Received: 13 November 2017 / Revised: 1 January 2018 / Accepted: 11 January 2018 / Published: 16 January 2018
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Abstract

It is unknown as to whether other beta-lactams can be used for bloodstream infections (BSI) resulting from Pseudomonas aeruginosa (PA) which are non-susceptible to one or more carbapenem. We conducted a retrospective cohort study at the Assaf Harofeh Medical Center (AHMC) from January 2010 to August 2014. Adult patients with PA-BSI non-susceptible to a group 2 carbapenem but susceptible to ceftazidime or piperacillin (with or without tazobactam), were enrolled. We compared the outcomes of patients who received an appropriate beta-lactam antibiotic (“cases”) to those who received an appropriate non-beta-lactam antibiotic (“controls”). Whole genome sequencing was performed for one of the isolates. Twenty-six patients with PA-BSI met inclusion criteria: 18 received a beta-lactam and 8 a non-beta-lactam (three a fluoroquinolone, two colistin, one a fluoroquinolone and an aminoglycoside, one a fluoroquinolone and colistin, and one colistin and an aminoglycoside). All clinical outcomes were similar between the groups. There were large variations in the phenotypic susceptibilities of the strains. A detailed molecular investigation of one isolate revealed a strain that belonged to MLST-137, with the presence of multiple efflux pumps, OXA-50, and a chromosomally mediated Pseudomonas-derived cephalosporinase (PDC). The oprD gene was intact. Non-carbapenem-β-lactams may still be effective alternatives for short duration therapy (up to 14 days) for BSI caused by a carbapenem non-susceptible (but susceptible to ceftazidime, piperacillin, and/or piperacillin-tazobactam) PA strain. This observation requires further confirmatory analyses. Future molecular investigations should be performed, in order to further analyze additional potential mechanisms for this prevalent phenotype. View Full-Text
Keywords: gram-negative; MDRO; non-fermenter; BSI; nosocomial infections; ICU gram-negative; MDRO; non-fermenter; BSI; nosocomial infections; ICU
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Zaidenstein, R.; Miller, A.; Tal-Jasper, R.; Ofer-Friedman, H.; Sklarz, M.; Katz, D.E.; Lazarovitch, T.; Lephart, P.R.; Mengesha, B.; Tzuman, O.; Dadon, M.; Daniel, C.; Moran-Gilad, J.; Marchaim, D. Therapeutic Management of Pseudomonas aeruginosa Bloodstream Infection Non-Susceptible to Carbapenems but Susceptible to “Old” Cephalosporins and/or to Penicillins. Microorganisms 2018, 6, 9.

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