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.

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