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Current review of antimicrobial treatment of nosocomial pneumonia caused by multidrug-resistant pathogens.

Abstract

Nosocomial pneumonia (including ventilator-associated pneumonia; VAP), a consistently difficult-to-treat entity, is frequently caused by multidrug-resistant (MDR) or pandrug-resistant (PDR) bacteria. Given the high mortality rates caused by drug-resistant bacteria and the difficulty of developing new potent antibiotics to target the problematic pathogens, combination regimens are under ardent evaluation as new strategies to overcome increasing drug resistance. Adjustment of the administration method of certain β-lactams (meropenem, or imipenem/cilastatin), or combination of tigecycline with some agents, may show promise with regard to successful management of MDR or PDR Acinetobacter baumannii pneumonia. Additionally, vancomycin plus rifampicin is an effective regimen against nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) responding poorly to vancomycin monotherapy. The clinical appropriateness of parenteral colistin against pneumonia caused by MDR A. baumannii has been established in a clinical trial. Facing the decline of clinical vancomycin efficacy after initial use, linezolid might be the drug of choice with regard to the treatment of MRSA-VAP. The role of tigecycline monotherapy for the management of nosocomial pneumonia caused by MRSA and extended-spectrum β-lactamase-producing Enterobacteriaceae needs to be cautiously evaluated.

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  • Publisher Full Text
  • Authors

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    Source

    Expert opinion on pharmacotherapy 12:14 2011 Oct pg 2145-8

    MeSH

    Acinetobacter Infections
    Acinetobacter baumannii
    Anti-Bacterial Agents
    Cross Infection
    Drug Resistance, Multiple, Bacterial
    Drug Therapy, Combination
    Humans
    Pneumonia, Bacterial
    Staphylococcal Infections
    Staphylococcus aureus

    Pub Type(s)

    Editorial
    Review

    Language

    eng

    PubMed ID

    21895553

    Citation

    TY - JOUR T1 - Current review of antimicrobial treatment of nosocomial pneumonia caused by multidrug-resistant pathogens. AU - Jean,Shio-Shin, AU - Hsueh,Po-Ren, PY - 2011/9/8/entrez PY - 2011/9/8/pubmed PY - 2012/1/14/medline SP - 2145 EP - 8 JF - Expert opinion on pharmacotherapy JO - Expert Opin Pharmacother VL - 12 IS - 14 N2 - Nosocomial pneumonia (including ventilator-associated pneumonia; VAP), a consistently difficult-to-treat entity, is frequently caused by multidrug-resistant (MDR) or pandrug-resistant (PDR) bacteria. Given the high mortality rates caused by drug-resistant bacteria and the difficulty of developing new potent antibiotics to target the problematic pathogens, combination regimens are under ardent evaluation as new strategies to overcome increasing drug resistance. Adjustment of the administration method of certain β-lactams (meropenem, or imipenem/cilastatin), or combination of tigecycline with some agents, may show promise with regard to successful management of MDR or PDR Acinetobacter baumannii pneumonia. Additionally, vancomycin plus rifampicin is an effective regimen against nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus (MRSA) responding poorly to vancomycin monotherapy. The clinical appropriateness of parenteral colistin against pneumonia caused by MDR A. baumannii has been established in a clinical trial. Facing the decline of clinical vancomycin efficacy after initial use, linezolid might be the drug of choice with regard to the treatment of MRSA-VAP. The role of tigecycline monotherapy for the management of nosocomial pneumonia caused by MRSA and extended-spectrum β-lactamase-producing Enterobacteriaceae needs to be cautiously evaluated. SN - 1744-7666 UR - https://www.unboundmedicine.com/medline/citation/21895553/abstract/Current_review_of_antimicrobial_treatment_of_nosocomial_pneumonia_caused_by_multidrug_resistant_pathogens_ L2 - http://informahealthcare.com/doi/abs/10.1517/14656566.2011.599320 ER -