title: Use of aztreonam in association with cefepime for the treatment of nosocomial infections due to multidrug-resistant strains of Pseudomonas aeruginosa to β-lactams in ICU patients: A pilot study.
abstract: OBJECTIVE
  Resistance to all β-lactams is emerging among Pseudomonas aeruginosa (PA) clinical isolates. Aztreonam and cefepime act synergistically in vitro against AmpC overproducing PA isolates. The objective of this study was to evaluate the clinical efficacy of this treatment in ICU patients infected with multidrug-resistant PA.
  
  
  METHODS
  Retrospective study (2 years, 2 ICUs) in a tertiary university hospital. Inclusion criteria were proven infection with evidence of a bacterial strain of PA resistant to all β-lactams and treated with the association of at least aztreonam plus cefepime. Treatment was considered effective for pneumonia using CPIS scores at the end of treatment and for other infections, using the SOFA score and signs of infection improvement at the end of treatment. Infectious episodes were classified as cure or failure.
  
  
  RESULTS
  Thirteen patients were included (10 nosocomial pneumonia, 3 nosocomial intra-abdominal infections). The median [25th-75th percentiles] admission SAPS2 score was 54 [51-69] and the median SOFA score at the beginning of infection was 7 [4-8]. The median CPIS scores for pneumonia at the beginning and end of treatment were 9 [7-10.5] and 2 [0.75-5.5]. The duration of treatment with the combination of aztreonam plus cefepime was 14 days [9.5-16]. Nine episodes were classified as cures and 4 as failures, indicating a clinical efficacy of 69.2%. Overall mortality was 38.5%.
  
  
  CONCLUSIONS
  These data suggest that the association of cefepime plus aztreonam could be an attractive alternative in the treatment of infections with multidrug-resistant PA to all β-lactams with a clinical efficacy rate of 69%.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France; Inserm U1088, University of Picardy - Jules-Verne, Amiens, France. Electronic address: dupont.herve@chu-amiens.fr.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France.
authors.forename: Sandra
authors.initials: S
authors.lastname: Marciniak
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France; Inserm U1088, University of Picardy - Jules-Verne, Amiens, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.affiliation: Department of Bacteriology, University Hospital of Amiens, Amiens, France.
authors.forename: Hedi
authors.initials: H
authors.lastname: Mammeri
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France; Inserm U1088, University of Picardy - Jules-Verne, Amiens, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Friggeri
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France.
authors.forename: Nacim
authors.initials: N
authors.lastname: Ammenouche
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Levrard
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France.
authors.forename: Norair
authors.initials: N
authors.lastname: Airapetian
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France.
authors.forename: François
authors.initials: F
authors.lastname: Tinturier
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, University Hospital of Amiens, Amiens, France; Inserm U1088, University of Picardy - Jules-Verne, Amiens, France.
authors.forename: Yazine
authors.initials: Y
authors.lastname: Mahjoub
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001398:Aztreonam / Q000627:therapeutic use*; D001426:Bacterial Proteins / Q000235:genetics; D000077723:Cefepime; D002511:Cephalosporins / Q000627:therapeutic use*; D003422:Critical Care; D003428:Cross Infection / Q000188:drug therapy* / Q000382:microbiology*; D004338:Drug Combinations; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010865:Pilot Projects; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000382:microbiology; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000235:genetics; D012189:Retrospective Studies; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D002511:Cephalosporins; D004338:Drug Combinations; D000077723:Cefepime; C048795:AmpC beta-lactamases; D001618:beta-Lactamases; D001398:Aztreonam
keywords: AmpC; Aztreonam; Cefepime; Multiresistant; Pneumonia; Pseudomonas aeruginosa