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In vitro activity and pharmacodynamics of commonly used antibiotics against adult systemic isolates of Escherichia coli and Pseudomonas aeruginosa at Forty US Hospitals.

Abstract：

BACKGROUND:Treatment of infections caused by gram-negative bacilli is increasingly challenging because of emerging resistance. Current surveillance data are informative, but may not discern differences by infection site and clinical setting, and do not incorporate pharmacodynamic (PD) characteristics when determining susceptibility. OBJECTIVES:This study explored the differences in infection site and clinical setting and evaluated dose-optimization strategies using PD principles. The stud focused only on systemic isolates, and targeted a cohort of 40 hospitals in the United States with a nationwide geographic distribution. METHODS:Nonduplicate, nonurine isolates of Escherichia coli (n = 937) and Pseudomonas aeruginosa (n = 1044) collected from adult patients at 40 US hospitals underwent MIC testing by broth microdilution to 15 agents. Results were analyzed by infection site and unit type (ward or intensive care unit [ICU]). PD modeling employing Monte Carlo simulation was used to predict the microbiologic success of varying dosing strategies. RESULTS:E coli were highly susceptible except to fluoroquinolones; 6.8% were multidrug resistant (MDR) and were more likely in ICUs (risk ratio [RR], 2.5; 95% CI, 1.6-4.0). P aeruginosa displayed 90% for most drug classes), with the important exception of the fluoroquinolones; however, susceptibility of P aeruginosa is low enough to warrant concern. Attention to the source of the organism and the patient's location in an ICU or a ward-combined with knowledge of local epidemiology and PD principles--should prove valuable in empiric agent selection. Additionally, reassessment of breakpoints employing PD principles is recommended, particularly for fluoroquinolones and piperacillin/tazobactam.

journal_name

Clin Ther

journal_title

Clinical therapeutics

authors

Eagye KJ,Kuti JL,Sutherland CA,Christensen H,Nicolau DP

doi

10.1016/j.clinthera.2009.11.021

subject

Has Abstract

pub_date

2009-11-01 00:00:00

pages

2678-88

issue

eissn

0149-2918

issn

1879-114X

pii

S0149-2918(09)00411-1

journal_volume

pub_type

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In vitro activity and pharmacodynamics of commonly used antibiotics against adult systemic isolates of Escherichia coli and Pseudomonas aeruginosa at Forty US Hospitals.