Antimicrobial therapy and control of multidrug-resistant Pseudomonas aeruginosa bacteremia in a teaching hospital in Taiwan
Ching-Hsiang Leung, Nai-Yu Wang, Chang-Pan Liu, Li-Chuan Weng, Feng-Chih Hsieh, Chun-Ming Lee
Division of Endocrinology and Metabolism, Department of Medicine, Microbiology Section, Department of Medical Research, and Division of Infectious Diseases, Department of Medicine, Mackay Memorial Hospital; Mackay Medicine Nursing and Management College; and Taipei Medical University, Taipei, Taiwan
Received: December 1, 2007 Revised: January 9, 2008 Accepted: February 28, 2008
Background and purpose:
The emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa is a challenging clinical problem. This study investigated the source of an outbreak of MDR P. aeruginosa infections and the role of combination therapy in its management.
MDR P. aeruginosa isolates were collected at the MacKay Memorial Hospital, Taipei, Taiwan, and antibiotic synergy was investigated based on antibiotic susceptibility tests using a combination of antibiotics. Isolates of patients with MDR P. aeruginosa bacteremia were selected for genetic analysis by pulsed-field gel electrophoresis.
A combination of ceftazidime, amikacin, and sulbactam had significant synergistic effects against bloodstream MDR P. aeruginosa isolates and was more beneficial clinically compared with other antibiotic combinations. The major source of MDR P. aeruginosa infection was located and stringent infection control measures were enforced.
The results of this study suggest that use of triple antimicrobial therapy (ceftazidime, amikacin, and sulbactam) can be a useful alternative treatment for MDR P. aeruginosa infection in certain circumstances.
Anti-infective agents; Bacteremia; Colistin; Drug resistance, multiple; Pseudomonas aeruginosa; Sulbactam
J Microbiol Immunol Infect. 2008;41:491-498.