Pseudomonas aeruginosa - Revision history

Aidan: moved MDR into own section in Background

2023-07-11T15:35:32Z

moved MDR into own section in Background

← Older revision		Revision as of 15:35, 11 July 2023
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	*Oxidase [[Oxidase::positive]], non-fermenting [[Stain::Gram-negative]] [[Shape::bacillus]]		*Oxidase [[Oxidase::positive]], non-fermenting [[Stain::Gram-negative]] [[Shape::bacillus]]

			=== Definitions of Drug Resistance ===

			* '''Multidrug resistant (MDR)''' is defined as non-susceptibility to at least 1 antibiotic in at least 3 antibiotic classes (penicillins, cephalosporins, fluoroquinolones, aminoglycosides, and carbapanems)
			** Results from decreased OprD, AmpC hyperproduction, upregulation of efflux pumps, and PBP target mutations
			** Carbapenemase production is uncommon but increasing
			* '''Extensively drug-resistant (XDR)''' is resistant to more than one antimicrobial agent in all the antimicrobial categories, except in two or less
			* '''Pan-drug-resistant (PDR)''' is resistant to all antimicrobial agents in all antimicrobial categories

	===Mechanisms of Resistance===		===Mechanisms of Resistance===

Aidan: /* Multidrug-Resistant Isolates */

2022-08-30T13:22:59Z

Multidrug-Resistant Isolates

← Older revision		Revision as of 13:22, 30 August 2022
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	*Refer to [[antipseudomonal antibiotics]] for specific treatment options		*Refer to [[antipseudomonal antibiotics]] for specific treatment options
	*Preferred: [[piperacillin-tazobactam]], [[ceftazidime]], [[cefepime]], [[aztreonam]]		*Preferred: [[piperacillin-tazobactam]], [[ceftazidime]], [[cefepime]], [[aztreonam]]
	**If resistant to carbapenems but ~~susceptible~~ to other β-lactams (most commonly caused by decreased OprD), use an extended infusion		**If repeat testing confirms resistant to carbapenems but susceptibility to other β-lactams (which is most commonly caused by decreased OprD), use an extended infusion of a β-lactam
	*Alternatives: [[meropenem]] or [[imipenem]]		*Alternatives: [[meropenem]] or [[imipenem]]
	*Double coverage (ß-lactam + non-ß-lactam) in cases of severe infection in order to ensure activity against the infection		*Double coverage (ß-lactam + non-ß-lactam) in cases of severe infection in order to ensure activity against the infection

Aidan: /* Mechanisms of Resistance */

2022-08-30T13:07:02Z

Mechanisms of Resistance

← Older revision		Revision as of 13:07, 30 August 2022
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	*Broad intrinsic and acquired antibiotic resistance[[CiteRef::livermore2002mu]]		*Broad intrinsic and acquired antibiotic resistance[[CiteRef::livermore2002mu]]
	*Membrane impermeability		*Membrane impermeability
	**Decreased or absent OprD porin: resistance to [[carbapenems]] ([[imipenem]] and [[meropenem]])		**Decreased or absent OprD porin: resistance to [[carbapenems]] ([[imipenem]] and [[meropenem]]) that may spare other β-lactams
	**Membrane changes: resistance to polymixins ([[colistin]])		**Membrane changes: resistance to polymixins ([[colistin]])
	**Reduced aminoglycoside transport: resistance to [[aminoglycosides]]		**Reduced aminoglycoside transport: resistance to [[aminoglycosides]]

Aidan at 13:06, 30 August 2022

2022-08-30T13:06:22Z

← Older revision		Revision as of 13:06, 30 August 2022
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	*Refer to [[antipseudomonal antibiotics]] for specific treatment options		*Refer to [[antipseudomonal antibiotics]] for specific treatment options
			*Preferred: [[piperacillin-tazobactam]], [[ceftazidime]], [[cefepime]], [[aztreonam]]
			**If resistant to carbapenems but susceptible to other β-lactams (most commonly caused by decreased OprD), use an extended infusion
			*Alternatives: [[meropenem]] or [[imipenem]]
	*Double coverage (ß-lactam + non-ß-lactam) in cases of severe infection in order to ensure activity against the infection		*Double coverage (ß-lactam + non-ß-lactam) in cases of severe infection in order to ensure activity against the infection

	=== Multidrug-Resistant Isolates ===		=== Multidrug-Resistant Isolates ===

			* MDR-PA is defined as non-susceptibility to at least 1 antibiotic in at least 3 antibiotic classes (penicillins, cephalosporins, fluoroquinolones, aminoglycosides, and carbapanems)
			** Results from decreased OprD, AmpC hyperproduction, upregulation of efflux pumps, and PBP target mutations
			** Carbapenemase production is uncommon but increasing
			* Difficult-to-treat [[Pseudomonas aeruginosa]] is defined as non-susceptibility to all of: [[piperacillin-tazobactam]], [[ceftazidime]], [[cefepime]], [[aztreonam]], [[meropenem]], [[imipenem-cilastatin]], [[ciprofloxacin]], and [[levofloxacin]]
	* Consider any of the following options:		* Consider any of the following options:
	** [[Amikacin]] 20 mg/kg IV once, followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])		** [[Amikacin]] 20 mg/kg IV once, followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])

Aidan: /* Multidrug Resistant Isolates */

2021-11-24T19:28:07Z

Multidrug Resistant Isolates

← Older revision		Revision as of 19:28, 24 November 2021
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	*Double coverage (ß-lactam + non-ß-lactam) in cases of severe infection in order to ensure activity against the infection		*Double coverage (ß-lactam + non-ß-lactam) in cases of severe infection in order to ensure activity against the infection

	=== Multidrug Resistant Isolates ===		=== Multidrug-Resistant Isolates ===

	* Consider any of the following options:		* Consider any of the following options:

Aidan: /* Multidrug Resistant Isolates */

2021-11-24T19:27:55Z

Multidrug Resistant Isolates

Aidan: /* Treatment */

2021-11-24T19:24:58Z

Treatment

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 *Refer to [[antipseudomonal antibiotics]] for specific treatment options
 *Double coverage (ß-lactam + non-ß-lactam) in cases of severe infection in order to ensure activity against the infection
 {{DISPLAYTITLE:''Pseudomonas aeruginosa''}}

Aidan: Text replacement - "[[Cellular shape::" to "[[Shape::"

2020-10-08T14:20:49Z

Text replacement - "[[Cellular shape::" to "[[Shape::"

← Older revision		Revision as of 14:20, 8 October 2020
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	===Microbiology===		===Microbiology===

	*Oxidase [[Oxidase::positive]], non-fermenting [[Stain::Gram-negative]] [[~~Cellular shape~~::bacillus]]		*Oxidase [[Oxidase::positive]], non-fermenting [[Stain::Gram-negative]] [[Shape::bacillus]]

	===Mechanisms of Resistance===		===Mechanisms of Resistance===

Aidan: /* Mechanisms of Resistance */

2020-09-21T14:45:20Z

Mechanisms of Resistance

← Older revision		Revision as of 14:45, 21 September 2020
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	*Broad intrinsic and acquired antibiotic resistance[[CiteRef::livermore2002mu]]		*Broad intrinsic and acquired antibiotic resistance[[CiteRef::livermore2002mu]]
	*Membrane impermeability		*Membrane impermeability
	**Decreased or absent OprD porin: resistance to carbapenems ([[imipenem]] and [[meropenem]])		**Decreased or absent OprD porin: resistance to [[carbapenems]] ([[imipenem]] and [[meropenem]])
	**Membrane changes: resistance to polymixins ([[colistin]])		**Membrane changes: resistance to polymixins ([[colistin]])
	**Reduced aminoglycoside transport: resistance to [[aminoglycosides]]		**Reduced aminoglycoside transport: resistance to [[aminoglycosides]]
	*Efflux pumps		*Efflux pumps
	**MexAB-OprM: resistance to fluoroquinolones and all β-lactams except [[imipenem]]		**MexAB-OprM: resistance to [[fluoroquinolones]] and all [[β-lactams]] except [[imipenem]]
	**MexCD-OprJ: resistance to fluoroquinolones and most β-lactams ([[cefoperazone]], [[cefpirome]], [[cefepime]], [[meropenem]]) but not [[imipenem]]		**MexCD-OprJ: resistance to [[fluoroquinolones]] and most [[β-lactams]] ([[cefoperazone]], [[cefpirome]], [[cefepime]], [[meropenem]]) but not [[imipenem]]
	**MexEF-OprN: resistance to fluoroquinolones and all β-lactams		**MexEF-OprN: resistance to [[fluoroquinolones]] and all [[β-lactams]]
	**MexXY-OprM: resistance to fluoroquinolones, most β-lactams (but not [[imipenem]]), and [[aminoglycosides]]		**MexXY-OprM: resistance to [[fluoroquinolones]], [[tetracyclines]] including [[tigecycline]], most [[β-lactams]] (but not [[imipenem]] or [[ceftazidime]]), and [[aminoglycosides]]
	*β-lactamases		*β-lactamases
	**Derepressed AmpC β-lactamase: resistance to penicillins and cephalosporins (except [[ceftolozane]])		**Derepressed AmpC β-lactamase: resistance to [[penicillins]] and [[cephalosporins]] (except [[ceftolozane]])
	**Acquired carbapenemases such as NDM-1: resistance to essentially all β-~~lactam antibiotics~~		**Acquired [[carbapenemases]] such as NDM-1: resistance to essentially all [[β-lactams]]
	*Aminoglycoside-modifying enzymes: resistance to [[aminoglycosides]]		*Aminoglycoside-modifying enzymes: resistance to [[aminoglycosides]]
	*Target site mutations		*Target site mutations
	**Topoisomerase II (gyrA) or IV (parC) point mutations: resistance to fluoroquinolones		**Topoisomerase II (gyrA) or IV (parC) point mutations: resistance to [[fluoroquinolones]]

	===Epidemiology===		===Epidemiology===

Aidan: /* Mechanisms of Resistance */

2020-09-15T12:36:56Z

Mechanisms of Resistance

← Older revision		Revision as of 12:36, 15 September 2020
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	===Mechanisms of Resistance===		===Mechanisms of Resistance===

	*Broad intrinsic and acquired antibiotic resistance		*Broad intrinsic and acquired antibiotic resistance[[CiteRef::livermore2002mu]]
	*Membrane impermeability		*Membrane impermeability
	**Decreased or absent OprD porin: resistance to carbapenems ([[imipenem]] and [[meropenem]])		**Decreased or absent OprD porin: resistance to carbapenems ([[imipenem]] and [[meropenem]])

← Older revision		Revision as of 19:27, 24 November 2021
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	=== Multidrug Resistant Isolates ===		=== Multidrug Resistant Isolates ===

	* Consider any of the following options		* Consider any of the following options:
	* [[Amikacin]] 20 mg/kg IV once, followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])		** [[Amikacin]] 20 mg/kg IV once, followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])
	* [[Cefiderocol]] 2 g IV 18h infused over 3 hours		** [[Cefiderocol]] 2 g IV 18h infused over 3 hours
	* [[Ceftazidime-avibactam]] 2.5 g IV q8h infused over 3 hours		** [[Ceftazidime-avibactam]] 2.5 g IV q8h infused over 3 hours
	* [[Ceftolozane-tazobactam]] 3 g IV q8h infused over 3 hours		** [[Ceftolozane-tazobactam]] 3 g IV q8h infused over 3 hours
	* [[Colistin]]		** [[Colistin]]
	* [[Gentamicin]] 7 mg/kg IV once followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])		** [[Gentamicin]] 7 mg/kg IV once followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])
	* [[Imipenem-relebactam]] 1.25 g IV q6h infused over 30 minutes		** [[Imipenem-relebactam]] 1.25 g IV q6h infused over 30 minutes
	* [[Plazomicin]] 15 mg/kg IV once followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])		** [[Plazomicin]] 15 mg/kg IV once followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])
	* [[Polymixin B]]		** [[Polymixin B]]
	* [[Tobramycin]] 7 mg/kg IV once followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])		** [[Tobramycin]] 7 mg/kg IV once followed by dosing per levels (see [[Aminoglycosides#Dosing\|Aminoglycosides]])
			*Preference for [[ceftolozane-tazobactam]], [[ceftazidime-avibactam]], and [[imipenem-relebactam]], as well as [[cefiderocol]] if UTI

	{{DISPLAYTITLE:''Pseudomonas aeruginosa''}}		{{DISPLAYTITLE:''Pseudomonas aeruginosa''}}