Impact of organism species on microbial eradication and development of resistance in severe gram-negative pneumonia

J Chemother. 2010 Apr;22(2):103-9. doi: 10.1179/joc.2010.22.2.103.

Abstract

This study evaluated the species differences in microbiological outcomes of Gram-negative bacteria (GNB) causing severe pneumonia from the viewpoint of area under the concentration-time curve/MIC ratio (AUC/MIC). In total, 111 strains of GNb from 74 patients were analyzed. Overall, microbiological eradication was achieved in 88% of the cases with initial AUC/MIC>119. However, relapse often occurred when resistance developed or AUC/miC was <176. Pseudomonas aeruginosa and Enterobacter spp. were commonly involved in failed microbiological eradication and development of resistance. The AUC/MIC required for initial eradication of P. aeruginosa was much higher (478) and antibiotic resistance in P. aeruginosa and Enterobacter spp. occurred less frequently with combination therapy (10.0% vs. 67.7%). These data argue that target magnitudes of AUC/MIC to eradicate GNB differ by species. Since antibiotic resistance developed in some species of GNB despite high AUC/MIC, strategies to minimize development of resistance, including combination therapy, must be considered.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use*
  • Area Under Curve
  • Double-Blind Method
  • Drug Resistance, Multiple, Bacterial*
  • Female
  • Gram-Negative Bacterial Infections / drug therapy*
  • Humans
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Pneumonia, Bacterial / drug therapy*
  • Pneumonia, Bacterial / microbiology
  • Recurrence

Substances

  • Anti-Bacterial Agents