Institut d'Investigació Sanitària Illes Balears (IdISBa) Research Group.

Antibiotic selection in the treatment of acute invasive infections by Pseudomonas aeruginosa: Guidelines by the Spanish Society of Chemotherapy.

Mensa J1, Barberán J2, Soriano A1, Llinares P3, Marco F4, Cantón R5, Bou G6, González Del Castillo J7, Maseda E8, Azanza JR9, Pasquau J10, García-Vidal C1, Reguera JM11, Sousa D3, Gómez J12, Montejo M13, Borges M14, Torres A15, Alvarez-Lerma F16, Salavert M17, Zaragoza R18, Oliver A19.

1Servicio de Enfermedades Infecciosas, Hospital Clinic, Barcelona, Spain
2Servicio de Medicina Enfermedades infecciosas, Hospital Universitario HM Montepríncipe, Universidad San Pablo CEU. Madrid, Spain
3Unidad de Enfermedades Infecciosas, Complejo Hospitalario Universitario A Coruña, Spain.
4Servicio de Microbiología, Hospital Clinic, Barcelona, Spain
5Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS). Madrid, Spain
6Servicio de Microbiología, Complejo Hospitalario Universitario A Coruña, Spain.
7Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain
8Servicio de Anestesiología, Hospital Universitario La Paz, Madrid, Spain
9Servicio de Farmacología, Clínica Universitaria de Navarra, Pamplona, Spain
10Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de la Nieves, Granada, Spain
11Servicio de Enfermedades Infecciosas, Hospital Universitario Carlos Haya, Málaga, Spain
12Servicio de Enfermedades Infecciosas, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
13Servicio de Enfermedades Infecciosas, Hospital Universitario Cruces, Bilbao, Spain
14Servicio de Medicina Intensiva, Hospital Son Llátzer, Palma de Mallorca, Spain
15Departamento de Neumología, Hospital Clinic, Barcelona, Spain
16Servicio de Medicina Intensiva, Hospital del Mar, Barcelona, Spain
17Unidad de Enfermedades Infecciosas. Hospital Univeristario la Fe, Valencia, Spain
18Servicio de Medicina Intensiva, Hospital Universitario Dr. Peset, Valencia, Spain
19Servicio de Microbiología, Hospital Universitari Son Espases, Instituto de Investigación Sanitaria Illes Balears (idISBa), Palma de Mallorca, Spain.

Pseudomonas aeruginosa is characterized by a notable intrinsic resistance to antibiotics, mainly mediated by the expression of inducible chromosomic β-lactamases and the production of constitutive or inducible efflux pumps. Apart from this intrinsic resistance, P. aeruginosa possess an extraordinary ability to develop resistance to nearly all available antimicrobials through selection of mutations. The progressive increase in resistance rates in P. aeruginosa has led to the emergence of strains which, based on their degree of resistance to common antibiotics, have been defined as multidrug resistant, extended-resistant and panresistant strains. These strains are increasingly disseminated worldwide, progressively complicating the treatment of P. aeruginosa infections. In this scenario, the objective of the present guidelines was to review and update published evidence for the treatment of patients with acute, invasive and severe infections caused by P. aeruginosa. To this end, mechanisms of intrinsic resistance, factors favoring development of resistance during antibiotic exposure, prevalence of resistance in Spain, classical and recently appeared new antibiotics active against P. aeruginosa, pharmacodynamic principles predicting efficacy, clinical experience with monotherapy and combination therapy, and principles for antibiotic treatment were reviewed to elaborate recommendations by the panel of experts for empirical and directed treatment of P. aeruginosa invasive infections.

Revista Española de Quimioterapia 2018;31(1): 78-100.

Link to Pubmed

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Dr. Bartolome Moyà

Instituto de Investigación Sanitaria Illes Balears

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