Am J Clin Microbiol Antimicrob | Volume 1, Issue 6 | Review Article | Open Access
Epps KL1, Epps QJ4, Mourad H1, Reger EB2 and Libertin CR3*
1Department of Pharmacy, Mayo Clinic, USA
2Department of Laboratory Medicine and Pathology, Mayo Clinic, USA
3Department of Infectious Diseases, Mayo Clinic, USA
4Department of Pharmacy, Florida Agricultural and Mechanical University, USA
*Correspondance to: Libertin CR
Fulltext PDFPurpose: The purpose of this study was to assess whether annual reporting by CSTD is adequate information for providers to best select empiric antimicrobial agents for Pseudomonas aeruginosa pneumonia in hospitalized patients. Also, this work investigated the advantage of using anatomic-site susceptibility data and created a combination antibiogram to determine which two antipseudomonal agents would offer the broadest empiric coverage.
Methods: A retrospective analysis was done on hospitalized patients treated at Mayo Clinic Florida who had P. aeruginosa isolated from January 1, 2016, through December 31, 2016. All P. aeruginosa isolates were categorized by anatomical site (blood, urine, abdomen and pelvis, soft tissue and skin, lungs, and miscellaneous). Anatomical-site and CSTD analyses were used to determine percentage of P. aeruginosa isolates susceptible to various antimicrobials. The primary objective was to assess whether differences in reporting between anatomical-site and CSTD alter antibiogram susceptibility percentages, and to determine which antimicrobial combination would provide the best empiric double coverage for P. aeruginosa. The primary objective was achieved by comparing the standard CSTD antibiogram to the anatomical-site antibiogram. Then, a combined susceptibility report of the two most commonly used agents at our institution, piperacillin tazobactam and cefepime with other agents was created in order to enhance the probability that the empiric coverage with an additional agent would offer inhibitory activity against P. aeruginosa with at least one of the two agents.
Results: CSTD showed that 90% of all P. aeruginosa isolates were susceptible to cefepime, but anatomical site data showed that only 85% of pulmonary isolates were susceptible. CSTD showed that 90% of all isolates were susceptible to piperacillin tazobactam, but anatomical site data showed that only 87% of pulmonary isolates were susceptible to piperacillin tazobactam. Anatomical site susceptibility data showed that more than 10% of P. aeruginosa isolates from pulmonary specimens were resistant to piperacillin tazobactam and cefepime. When combined with piperacillin tazobactam or cefepime, aminoglycosides showed the greatest inhibition of isolates obtained from patients with suggested P. aeruginosa pneumonia.
Conclusion: Reporting anatomical site data for P. aeruginosa and combination antibiograms, in addition to CSTD, provide improved guidance for empirical therapy against P. aeruginosa.
Anatomical site antibiogram; Antimicrobial stewardship programs; Combination antibiogram; Data stratification; Pseudomonas aeruginosa pneumonia empirical therapy
Epps KL, Epps QJ, Mourad H, Reger EB, Libertin CR. Is Annual Cumulative Susceptibility Test Data Enough to Guide Empirical Therapy for Pseudomonas aeruginosa Pneumonia? Am J Clin Microbiol Antimicrob. 2018; 1(6): 1026.