[Current microbiological problems. Antibiotic resistance and therapeutic problems raised by Pseudomonas aeruginosa].
Pseudomonas aeruginosa is characterized by its low intrinsic susceptibility to many antibiotics and its capacity to acquire additional resistance mechanisms to usually active drugs. Some beta-lactam resistance mechanisms are well known (penicillinase production, cephalosporinase overproduction) and others have been recently identified, such as active efflux systems, which confer coresistance to quinolones, and new beta-lactamases which are limited to a few countries (extended-spectrum beta-lactamases, imipenemase). Ceftazidime remains the most active beta-lactam agent. ACTIVE DRUGS: Among aminoglycosides, amikacin and isepamicin are the most frequently active drugs. The use of fluoroquinolones is limited by a high incidence of acquired resistance. The percentage of resistant strains is highly variable according to countries, hospitals and wards. CLINICAL PRACTICE: Therapy, usually based on a beta-lactam-aminoglycoside combination, will be empirical at first, according to local epidemiological factors, site of infection and previously administered antibiotics, then re-evaluated according to susceptibility results.
Bert
F
F
Service de Microbiologie, Hôpital Beaujon, Clichy. labo.microbio@bjn.ap-hop-paris.fr
Lambert-Zechovsky
N
N
D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology*; D004352:Drug Resistance, Microbial; D006801:Humans; D010405:Penicillinase / Q000494:pharmacology / Q000627:therapeutic use; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000276:immunology / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000276:immunology; D001618:beta-Lactamases / Q000494:pharmacology / Q000627:therapeutic use
D010405:Penicillinase; D001618:beta-Lactamases