Antimicrobial therapy and control of multidrug-resistant Pseudomonas aeruginosa bacteremia in a teaching hospital in Taiwan.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Leung
Ching-Hsiang
CH
Division of Endocrinology and Metabolism, Department of Medicine, Mackay Memorial Hospital, Taipei, Taiwan.
Wang
Nai-Yu
NY
Liu
Chang-Pan
CP
Weng
Li-Chuan
LC
Hsieh
Feng-Chih
FC
Lee
Chun-Ming
CM
D000368:Aged; D000369:Aged, 80 and over; D000583:Amikacin / Q000494:pharmacology / Q000627:therapeutic use; D000890:Anti-Infective Agents / Q000494:pharmacology / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy* / Q000382:microbiology; D002442:Ceftazidime / Q000494:pharmacology / Q000627:therapeutic use; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004357:Drug Synergism; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D012189:Retrospective Studies; D013407:Sulbactam / Q000494:pharmacology / Q000627:therapeutic use; D013624:Taiwan
D000890:Anti-Infective Agents; D000583:Amikacin; D002442:Ceftazidime; D013407:Sulbactam