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      Antibiotic Susceptibilities of Pseudomonas aeruginosa Isolated from Blood Samples and Antibiotic Utilization in a University Hospital in Japan

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          Abstract

          Introduction

          Pseudomonas aeruginosa is one of the most important causes of nosocomial infection. Several reports indicated a correlation of antimicrobial usages and declined susceptibilities. In this report, we evaluated their relation in a tertiary care teaching hospital in Tokyo, Japan for 4 years.

          Methods

          We evaluated the susceptibilities of 149 strains of P. aeruginosa isolated from blood samples and consumption of anti-pseudomonal antibiotics as antimicrobial use density from 2009 to 2012 in the University of Tokyo Hospital in Tokyo, Japan.

          Results

          Usages of carbapenems and anti-pseudomonal cephalosporins decreased 44% and 31% from 2009 to 2011, and then increased 30% and 24% in 2012, respectively. Usage of piperacillin–tazobactam increased 87% from 2009 to 2012, which was introduced in the hospital in 2008. Consumption of fluoroquinolones and aminoglycoside remained low in those years. Susceptibilities to cephalosporins, carbapenems (except for panipenem–betamipron), penicillins, and fluoroquinolones declined between 22% and 39% in 2010, increased in the range of 16–31% in 2011, and increased by 1–14% in 2012. Susceptibility of panipenem–betamipron ranged between 25% and 32%. Susceptibility to aminoglycoside was more than 90% during this period. No relationship between antimicrobial usages and susceptibilities of P. aeruginosa was observed.

          Conclusion

          Susceptibilities of P. aeruginosa did not correlate with the usage of antibiotics in our hospital. Several infection control measures and other factors might contribute to changing the susceptibilities of bacteria.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s40121-015-0066-x) contains supplementary material, which is available to authorized users.

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          Most cited references14

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          Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.

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            Pseudomonas aeruginosa: a formidable and ever-present adversary.

            Pseudomonas aeruginosa is a versatile pathogen associated with a broad spectrum of infections in humans. In healthcare settings the bacterium is an important cause of infection in vulnerable individuals including those with burns or neutropenia or receiving intensive care. In these groups morbidity and mortality attributable to P. aeruginosa infection can be high. Management of infections is difficult as P. aeruginosa is inherently resistant to many antimicrobials. Furthermore, treatment is being rendered increasingly problematic due to the emergence and spread of resistance to the few agents that remain as therapeutic options. A notable recent development is the acquisition of carbapenemases by some strains of P. aeruginosa. Given these challenges, it would seem reasonable to identify strategies that would prevent acquisition of the bacterium by hospitalised patients. Environmental reservoirs of P. aeruginosa are readily identifiable, and there are numerous reports of outbreaks that have been attributed to an environmental source; however, the role of such sources in sporadic pseudomonal infection is less well understood. Nevertheless there is emerging evidence from prospective studies to suggest that environmental sources, especially water, may have significance in the epidemiology of sporadic P. aeruginosa infections in hospital settings, including intensive care units. A better understanding of the role of environmental reservoirs in pseudomonal infection will permit the development of new strategies and refinement of existing approaches to interrupt transmission from these sources to patients.
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              Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium.

              Pseudomonas aeruginosa is a major cause of nosocomial infections. This organism shows a remarkable capacity to resist antibiotics, either intrinsically (because of constitutive expression of beta-lactamases and efflux pumps, combined with low permeability of the outer-membrane) or following acquisition of resistance genes (e.g., genes for beta-lactamases, or enzymes inactivating aminoglycosides or modifying their target), over-expression of efflux pumps, decreased expression of porins, or mutations in quinolone targets. Worryingly, these mechanisms are often present simultaneously, thereby conferring multiresistant phenotypes. Susceptibility testing is therefore crucial in clinical practice. Empirical treatment usually involves combination therapy, selected on the basis of known local epidemiology (usually a beta-lactam plus an aminoglycoside or a fluoroquinolone). However, therapy should be simplified as soon as possible, based on susceptibility data and the patient's clinical evolution. Alternative drugs (e.g., colistin) have proven useful against multiresistant strains, but innovative therapeutic options for the future remain scarce, while attempts to develop vaccines have been unsuccessful to date. Among broad-spectrum antibiotics in development, ceftobiprole, sitafloxacin and doripenem show interesting in-vitro activity, although the first two molecules have been evaluated in clinics only against Gram-positive organisms. Doripenem has received a fast track designation from the US Food and Drug Administration for the treatment of nosocomial pneumonia. Pump inhibitors are undergoing phase I trials in cystic fibrosis patients. Therefore, selecting appropriate antibiotics and optimising their use on the basis of pharmacodynamic concepts currently remains the best way of coping with pseudomonal infections.
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                Author and article information

                Contributors
                suzukima-int@h.u-tokyo.ac.jp
                Journal
                Infect Dis Ther
                Infect Dis Ther
                Infectious Diseases and Therapy
                Springer Healthcare (Cheshire )
                2193-8229
                2193-6382
                20 May 2015
                20 May 2015
                June 2015
                : 4
                : 2
                : 213-218
                Affiliations
                [ ]Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
                [ ]Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
                Article
                66
                10.1007/s40121-015-0066-x
                4471057
                25991512
                01400a68-f1be-49d8-9e79-31f441c2b52a
                © The Author(s) 2015
                History
                : 10 April 2015
                Categories
                Brief Report
                Custom metadata
                © Springer Healthcare 2015

                antimicrobial usage,pseudomonas aeruginosa,susceptibility

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