Podcast
Questions and Answers
Which of the following is a primary objective when managing HAP/VAP?
Which of the following is a primary objective when managing HAP/VAP?
- Minimizing hospital costs above all else
- Prescribing the newest antibiotic available
- Identifying likely causative organisms (correct)
- Ignoring potential adverse drug events
What is a key consideration when modifying a patient's treatment plan for pneumonia?
What is a key consideration when modifying a patient's treatment plan for pneumonia?
- Efficacy, adverse events, and follow-up assessment (correct)
- The patient's preference for medication route
- Advertising claims made by pharmaceutical companies
- The cost of the medication, regardless of efficacy
What is the required time frame post hospital admission for classifying pneumonia as HAP?
What is the required time frame post hospital admission for classifying pneumonia as HAP?
- Within 72 hours of admission
- At the time of admission
- More than 48 hours (correct)
- Less than 24 hours
What is the required time frame after endotracheal intubation for classifying pneumonia as VAP?
What is the required time frame after endotracheal intubation for classifying pneumonia as VAP?
What is the definition of Community-Acquired Pneumonia (CAP)?
What is the definition of Community-Acquired Pneumonia (CAP)?
Which of the following is a common cause of HAP?
Which of the following is a common cause of HAP?
What is the typical percentage of Pseudomonas aeruginosa in HAP cases?
What is the typical percentage of Pseudomonas aeruginosa in HAP cases?
Which of the following is the most common hospital-acquired infection?
Which of the following is the most common hospital-acquired infection?
True or False: The diagnosis of nosocomial pneumonia relies predominately on laboratory findings.
True or False: The diagnosis of nosocomial pneumonia relies predominately on laboratory findings.
What is the recommended method for determining the mortality risk in patients with pneumonia?
What is the recommended method for determining the mortality risk in patients with pneumonia?
What should local antibiograms and patient cultures be used for?
What should local antibiograms and patient cultures be used for?
Why is it important to cover for MSSA, P. aeruginosa, and Gram-negative bacilli in pneumonia treatment?
Why is it important to cover for MSSA, P. aeruginosa, and Gram-negative bacilli in pneumonia treatment?
What is meropenem's classification?
What is meropenem's classification?
Which of the following factors increases the risk of MRSA?
Which of the following factors increases the risk of MRSA?
A patient that had a previous hospital stay of 26 days has what increased risk?
A patient that had a previous hospital stay of 26 days has what increased risk?
According to presented information, which empiric treatment is best for a low risk of mortality and low risk for MRSA patient with HAP?
According to presented information, which empiric treatment is best for a low risk of mortality and low risk for MRSA patient with HAP?
According to presented information, which empiric treatment is best for a high risk of mortality and high risk for MDR patient with HAP?
According to presented information, which empiric treatment is best for a high risk of mortality and high risk for MDR patient with HAP?
According to presented information, which empiric treatment is best for a patient with low risk of mortality and GN-r <10% and MRSA <10% with VAP?
According to presented information, which empiric treatment is best for a patient with low risk of mortality and GN-r <10% and MRSA <10% with VAP?
Which of the following drugs is associated with a 'red-man syndrome'?
Which of the following drugs is associated with a 'red-man syndrome'?
Which of the following medications should NEVER be used for pneumonia?
Which of the following medications should NEVER be used for pneumonia?
For which organism should polymyxin susceptibility be routinely assessed?
For which organism should polymyxin susceptibility be routinely assessed?
Which of the following best describes the antimicrobial stewardship approach for treating pneumonia?
Which of the following best describes the antimicrobial stewardship approach for treating pneumonia?
Which of the following is NOT a newer drug option?
Which of the following is NOT a newer drug option?
What is a benefit to using short courses when treating HAP/VAP?
What is a benefit to using short courses when treating HAP/VAP?
According to presented information, which factor needs to be included to make the best recommendation?
According to presented information, which factor needs to be included to make the best recommendation?
If a patient is allergic to penicillin, what should be considered?
If a patient is allergic to penicillin, what should be considered?
When is polymyxin B recommended to be used?
When is polymyxin B recommended to be used?
If a patient shows signs of 'red man syndrome' while receiving a vancomycin infusion, what is the first step that should be taken?
If a patient shows signs of 'red man syndrome' while receiving a vancomycin infusion, what is the first step that should be taken?
Which of the following is the benefit of using inhaled antibiotics?
Which of the following is the benefit of using inhaled antibiotics?
What is the disadvantage of using inhaled antibiotics?
What is the disadvantage of using inhaled antibiotics?
Which approach is best to guide early discontinuation of antibiotics in VAP?
Which approach is best to guide early discontinuation of antibiotics in VAP?
When using inhaled antibiotics, what needs to be identified?
When using inhaled antibiotics, what needs to be identified?
Which of the organisms listed is most likely responsible for HAP/VAP?
Which of the organisms listed is most likely responsible for HAP/VAP?
What is the primary goal when selecting antibiotics for HAP/VAP?
What is the primary goal when selecting antibiotics for HAP/VAP?
What is the significance of procalcitonin levels in the management of pneumonia?
What is the significance of procalcitonin levels in the management of pneumonia?
Which of the following is a risk factor for resistant organisms in HAP/VAP?
Which of the following is a risk factor for resistant organisms in HAP/VAP?
Which of the following most impacts the decision to add MRSA coverage?
Which of the following most impacts the decision to add MRSA coverage?
What is a significant risk factor that may influence the decision to use dual antipseudomonal coverage in the treatment of HAP/VAP?
What is a significant risk factor that may influence the decision to use dual antipseudomonal coverage in the treatment of HAP/VAP?
A patient is diagnosed with HAP and septic shock. Initial cultures are pending. Which treatment strategy is most appropriate?
A patient is diagnosed with HAP and septic shock. Initial cultures are pending. Which treatment strategy is most appropriate?
What is the primary rationale for performing routine antimicrobial susceptibility testing for P. aeruginosa isolates in pneumonia cases?
What is the primary rationale for performing routine antimicrobial susceptibility testing for P. aeruginosa isolates in pneumonia cases?
What is an established benefit of using short courses (7-8 days) of antibiotics for HAP/VAP compared to longer courses (10-15 days)?
What is an established benefit of using short courses (7-8 days) of antibiotics for HAP/VAP compared to longer courses (10-15 days)?
What is a key consideration when using inhaled antibiotics for HAP/VAP?
What is a key consideration when using inhaled antibiotics for HAP/VAP?
What is a potential advantage of using inhaled antibiotics in the treatment of pneumonia?
What is a potential advantage of using inhaled antibiotics in the treatment of pneumonia?
What is a notable limitation associated with the use of inhaled polymyxin B in the treatment of pneumonia?
What is a notable limitation associated with the use of inhaled polymyxin B in the treatment of pneumonia?
Which factor should be considered when selecting antibiotics for pneumonia caused by extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli?
Which factor should be considered when selecting antibiotics for pneumonia caused by extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli?
Which factor is a characteristic used to define ventilator-associated pneumonia (VAP)?
Which factor is a characteristic used to define ventilator-associated pneumonia (VAP)?
Which statement accurately describes the general principles of antibiotic use and resistance?
Which statement accurately describes the general principles of antibiotic use and resistance?
What is one of the likely organisms responsible for HAP/VAP?
What is one of the likely organisms responsible for HAP/VAP?
Which of the following is one of the likely organisms responsible for HAP/VAP?
Which of the following is one of the likely organisms responsible for HAP/VAP?
What is an important aspect of antibiotic stewardship in managing HAP/VAP beyond initial selection?
What is an important aspect of antibiotic stewardship in managing HAP/VAP beyond initial selection?
What is the primary justification for tailoring antibiotic selection based on local antibiograms and a patient's prior cultures?
What is the primary justification for tailoring antibiotic selection based on local antibiograms and a patient's prior cultures?
In which context is monotherapy with an aminoglycoside NOT recommended for treating pneumonia?
In which context is monotherapy with an aminoglycoside NOT recommended for treating pneumonia?
According to presented information, which of the following drugs is NEVER appropriate for treatment of pneumonia due to inactivation by surfactant?
According to presented information, which of the following drugs is NEVER appropriate for treatment of pneumonia due to inactivation by surfactant?
What is the target trough concentration of vancomycin?
What is the target trough concentration of vancomycin?
What is a potential adverse effect of linezolid therapy that prescribers should monitor for?
What is a potential adverse effect of linezolid therapy that prescribers should monitor for?
What is a risk factor for MRSA in VAP?
What is a risk factor for MRSA in VAP?
What is the recommendation for septic shock or at high mortality even if susceptibility is known?
What is the recommendation for septic shock or at high mortality even if susceptibility is known?
What is the recommendation when a patient with pneumonia that has pseudomonas resolves from septic shock
What is the recommendation when a patient with pneumonia that has pseudomonas resolves from septic shock
According to available evidence, what is the impact of using procalcitonin concentrations, associated with clinical indicators, to guide antibiotic discontinuation in HAP/VAP?
According to available evidence, what is the impact of using procalcitonin concentrations, associated with clinical indicators, to guide antibiotic discontinuation in HAP/VAP?
Upon review, a 31 yo male (RB) with no comorbidities is diagnosed with pneumonia and determined to have low risk of mortality and low risk for MRSA. Which of the following treatments would be most appropriate?
Upon review, a 31 yo male (RB) with no comorbidities is diagnosed with pneumonia and determined to have low risk of mortality and low risk for MRSA. Which of the following treatments would be most appropriate?
Upon review, a 59 yo female (AJ) on a mechanical ventilator for 3 days, since arriving to the ICU, and requires vasopressors due to ICU transfer from CHF, has been diagnosed with VAP. Which of the following treatments would be most appropriate?
Upon review, a 59 yo female (AJ) on a mechanical ventilator for 3 days, since arriving to the ICU, and requires vasopressors due to ICU transfer from CHF, has been diagnosed with VAP. Which of the following treatments would be most appropriate?
Upon review, a 59 yo female (AJ) on a mechanical ventilator at Day 4 requiring treatment for VAP, no longer needs vasopressors. A tracheal aspirate grew P. aeruginosa that is Meropenem Susceptible, but Pip-Tazo, Cefepime, and Aztreonam Resistant . Which of the following treatments would be most appropriate?
Upon review, a 59 yo female (AJ) on a mechanical ventilator at Day 4 requiring treatment for VAP, no longer needs vasopressors. A tracheal aspirate grew P. aeruginosa that is Meropenem Susceptible, but Pip-Tazo, Cefepime, and Aztreonam Resistant . Which of the following treatments would be most appropriate?
Which of the following is the best method to guide early discontinuation of antibiotics for VAP?
Which of the following is the best method to guide early discontinuation of antibiotics for VAP?
While polymyxin B and colistin, both historically used to treat pneumonia, can result in nephrotoxicity, which one requires a renal adjustment?
While polymyxin B and colistin, both historically used to treat pneumonia, can result in nephrotoxicity, which one requires a renal adjustment?
What accurately describes HAP?
What accurately describes HAP?
What statement best represents HAP impact?
What statement best represents HAP impact?
Which of the following is likely to display an increase in HAP/VAP?
Which of the following is likely to display an increase in HAP/VAP?
What is a key consideration when selecting empiric antibiotic therapy for HAP/VAP in a patient with a known history of structural lung disease?
What is a key consideration when selecting empiric antibiotic therapy for HAP/VAP in a patient with a known history of structural lung disease?
Which of the following is the most accurate definition of hospital-acquired pneumonia (HAP)?
Which of the following is the most accurate definition of hospital-acquired pneumonia (HAP)?
What is the main difference between HAP and VAP regarding their impact?
What is the main difference between HAP and VAP regarding their impact?
What is the most likely organism responsible for HAP if a patient has been on broad-spectrum antibiotics for an extended period?
What is the most likely organism responsible for HAP if a patient has been on broad-spectrum antibiotics for an extended period?
Which diagnostic approach is most accurate for identifying the causative pathogen in a patient with suspected HAP?
Which diagnostic approach is most accurate for identifying the causative pathogen in a patient with suspected HAP?
When should you consider the addition of MRSA coverage in the empiric treatment of HAP?
When should you consider the addition of MRSA coverage in the empiric treatment of HAP?
In a patient diagnosed with HAP who is at high risk for mortality and has risk factors for multi-drug resistant organisms, what empiric antibiotic strategy is the most appropriate?
In a patient diagnosed with HAP who is at high risk for mortality and has risk factors for multi-drug resistant organisms, what empiric antibiotic strategy is the most appropriate?
A patient with VAP has documented Pseudomonas aeruginosa with resistance to multiple antibiotics, but is susceptible to polymyxins. What is the most appropriate definitive therapy?
A patient with VAP has documented Pseudomonas aeruginosa with resistance to multiple antibiotics, but is susceptible to polymyxins. What is the most appropriate definitive therapy?
Which of the following statements best describes the role of inhaled antibiotics in the treatment of HAP/VAP?
Which of the following statements best describes the role of inhaled antibiotics in the treatment of HAP/VAP?
If a patient develops 'red man syndrome' during vancomycin infusion, what is the next step?
If a patient develops 'red man syndrome' during vancomycin infusion, what is the next step?
What is a consideration when selecting antibiotics for pneumonia caused by extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli?
What is a consideration when selecting antibiotics for pneumonia caused by extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli?
Which of the following is the MOST important factor when deciding to use dual antipseudomonal coverage in the treatment of HAP/VAP?
Which of the following is the MOST important factor when deciding to use dual antipseudomonal coverage in the treatment of HAP/VAP?
What is the primary purpose of tailoring antibiotic selection based on local antibiograms and a patient's prior cultures?
What is the primary purpose of tailoring antibiotic selection based on local antibiograms and a patient's prior cultures?
For a patient with VAP who initially presented with septic shock that has now resolved, and cultures identify a P. aeruginosa isolate susceptible to multiple agents, what is the guideline based recommendation.
For a patient with VAP who initially presented with septic shock that has now resolved, and cultures identify a P. aeruginosa isolate susceptible to multiple agents, what is the guideline based recommendation.
Which of the following is the MOST appropriate method for guiding early discontinuation of antibiotics in patients with VAP?
Which of the following is the MOST appropriate method for guiding early discontinuation of antibiotics in patients with VAP?
In managing HAP/VAP, what is the significance of considering both hospital-specific and unit-specific antibiograms?
In managing HAP/VAP, what is the significance of considering both hospital-specific and unit-specific antibiograms?
Which factor most significantly contributes to the increased risk of HAP/VAP in healthcare settings?
Which factor most significantly contributes to the increased risk of HAP/VAP in healthcare settings?
What is the primary limitation of relying solely on clinical criteria for diagnosing HAP/VAP?
What is the primary limitation of relying solely on clinical criteria for diagnosing HAP/VAP?
What is the rationale for avoiding daptomycin in the treatment of pneumonia?
What is the rationale for avoiding daptomycin in the treatment of pneumonia?
What is considered a risk factor that elevates your chances of acquiring a MRSA infection?
What is considered a risk factor that elevates your chances of acquiring a MRSA infection?
What factor is crucial when selecting antibiotics for pneumonia caused by carbapenem-resistant organisms?
What factor is crucial when selecting antibiotics for pneumonia caused by carbapenem-resistant organisms?
What is the most appropriate definition of VAP?
What is the most appropriate definition of VAP?
Why is antibiotic stewardship important for HAP/VAP, beyond the initial antibiotic selection?
Why is antibiotic stewardship important for HAP/VAP, beyond the initial antibiotic selection?
What best exemplifies how antimicrobial resistance impacts clinical decision-making in pneumonia treatment?
What best exemplifies how antimicrobial resistance impacts clinical decision-making in pneumonia treatment?
What distinguishes ventilator-associated pneumonia (VAP) from hospital-acquired pneumonia (HAP)?
What distinguishes ventilator-associated pneumonia (VAP) from hospital-acquired pneumonia (HAP)?
Which factor would MOST warrant the addition of MRSA coverage to an empiric antimicrobial regimen for HAP/VAP?
Which factor would MOST warrant the addition of MRSA coverage to an empiric antimicrobial regimen for HAP/VAP?
A patient with HAP is started on empiric antibiotics. Cultures subsequently grow Pseudomonas aeruginosa resistant to multiple antibiotics but susceptible to cefolozane-tazobactam. How does is change from the empiric regimen to a targeted approach?
A patient with HAP is started on empiric antibiotics. Cultures subsequently grow Pseudomonas aeruginosa resistant to multiple antibiotics but susceptible to cefolozane-tazobactam. How does is change from the empiric regimen to a targeted approach?
Among patients with HAP or VAP, what impact does the use of short-course (7-8 days) antibiotic therapy, compared to longer courses (10-15 days), have on clinical outcomes?
Among patients with HAP or VAP, what impact does the use of short-course (7-8 days) antibiotic therapy, compared to longer courses (10-15 days), have on clinical outcomes?
An ICU has seen an increase in HAP/VAP cases caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). What infection control measures should be prioritized?
An ICU has seen an increase in HAP/VAP cases caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). What infection control measures should be prioritized?
How can antibiotic cycling or mixing strategies BEST contribute to antimicrobial stewardship in the management of HAP/VAP?
How can antibiotic cycling or mixing strategies BEST contribute to antimicrobial stewardship in the management of HAP/VAP?
Which of the following best aligns with the goal of antibiotic stewardship for managing HAP/VAP?
Which of the following best aligns with the goal of antibiotic stewardship for managing HAP/VAP?
What approach is generally recommended to promote the safe discontinuation of antibiotics in VAP?
What approach is generally recommended to promote the safe discontinuation of antibiotics in VAP?
Flashcards
Hospital-Acquired Pneumonia (HAP)
Hospital-Acquired Pneumonia (HAP)
Pneumonia acquired in the hospital ≥48 hours after admission, not intubated at admission.
Ventilator-Associated Pneumonia (VAP)
Ventilator-Associated Pneumonia (VAP)
Pneumonia that develops ≥48 hours after endotracheal intubation.
Nosocomial Pneumonia Impact
Nosocomial Pneumonia Impact
Infections common in hospital settings, which increases care costs and extends hospital stays.
Nosocomial Pneumonia Diagnosis
Nosocomial Pneumonia Diagnosis
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Antibiotic Selection
Antibiotic Selection
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Empiric Coverage
Empiric Coverage
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Adjusting Therapy
Adjusting Therapy
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Treatment Duration
Treatment Duration
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Assessing Mortality Risk
Assessing Mortality Risk
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Procalcitonin use
Procalcitonin use
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Likely organisms HAP/VAP
Likely organisms HAP/VAP
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Risk factors for MRSA in HAP
Risk factors for MRSA in HAP
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Risk factors for MRSA in VAP
Risk factors for MRSA in VAP
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Risk factors for MDR in HAP/VAP
Risk factors for MDR in HAP/VAP
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HAP/VAP Organisms
HAP/VAP Organisms
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HAP/VAP risk factors
HAP/VAP risk factors
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HAP/VAP treatment guidelines
HAP/VAP treatment guidelines
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Pneumonia classification
Pneumonia classification
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Empiric Therapy
Empiric Therapy
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Treatment Adjustment
Treatment Adjustment
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HAP/VAP Diagnosis
HAP/VAP Diagnosis
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Antibiotic De-escalation
Antibiotic De-escalation
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Community-Acquired Pneumonia (CAP)
Community-Acquired Pneumonia (CAP)
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Vancomycin Dosing
Vancomycin Dosing
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Vancomycin Adverse Effects
Vancomycin Adverse Effects
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Alternative Agents
Alternative Agents
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Linezolid Dosing
Linezolid Dosing
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Best Guide
Best Guide
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Pseudomonas aeruginosa Treatment
Pseudomonas aeruginosa Treatment
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Acinetobacter spp. Treatment
Acinetobacter spp. Treatment
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Managing antibiotic
Managing antibiotic
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Study Notes
Lecture Objectives
- Recognize common organisms causing Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP).
- Identify risk factors associated with resistant organisms in HAP/VAP.
- Review the guideline-based care recommendations for adults with HAP/VAP.
- Categorize the type of pneumonia using patient information.
- Determine a suitable empiric or pathogen-directed treatment strategy.
- Consider modifications to a patient's treatment course based on efficacy, side effects, and follow-up tests.
Nosocomial Pneumonia Definitions
- Community-Acquired Pneumonia (CAP) occurs outside the healthcare setting and <48 hours from hospital admission.
- Hospital-Acquired Pneumonia (HAP) occurs ≥48 hours after hospital admission in patients not intubated upon admission.
- Ventilator-Associated Pneumonia (VAP) occurs ≥48 hours after endotracheal intubation.
Risk Factors for MRSA
- IV antibiotic in prior 90 days.
- Hospitalization in a unit where >20% MRSA or % unknown (HAP).
- Hospitalization in a unit where >10–20% MRSA or % unknown (VAP).
Risk Factors for MDR
- IV antibiotic in prior 90 days.
- Structural lung disease (bronchiectasis, cystic fibrosis) (HAP).
- Septic shock at time of VAP.
- ARDS preceding VAP.
- ≥5 days of hospitalization prior to the occurrence of VAP.
- Acute renal replacement therapy prior to VAP onset (VAP).
Empiric Treatment for HAP
- Low mortality risk and low MRSA risk: Piperacillin-tazobactam, cefepime, imipenem, or meropenem as monotherapy with BL or FQ Levofloxacin.
- Low mortality risk, high MRSA risk Piperacillin-tazobactam, cefepime, imipenem, meropenem, or aztreonam, with Levofloxacin or Ciprofloxacin, plus Vancomycin or Linezolid.
- High mortality / MDR risk: Piperacillin-tazobactam, cefepime, imipenem, meropenem, or aztreonam, with Levofloxacin or Ciprofloxacin, plus Amikacin, Gentamicin, or Tobramycin, plus Vancomycin or Linezolid.
Empiric Treatment for VAP
- No MDR risk, GN-r <10%, and MRSA <10%: Piperacillin-tazobactam, cefepime, imipenem, or meropenem with Levofloxacin.
- No MDR risk, GN-r <10%, MRSA >10% or unknown: Piperacillin-tazobactam, cefepime, imipenem, meropenem, or aztreonam with Levofloxacin or Ciprofloxacin, plus Vancomycin or Linezolid.
- No risk for MDR, GN-r >10%, MRSA >10% or unknown: Piperacillin-tazobactam, cefepime, imipenem, meropenem, or aztreonam, with Levofloxacin or Ciprofloxin, Amikacin, Gentamicin, or TobramycinColistin, and Polymyxin B, plus Vancomycin or Linezolid.
- Risk for MDR: Piperacillin-tazobactam, cefepime, imipenem, meropenem, or aztreonam with Levofloxacin or Ciprofloxacin, Amikacin, Gentamicin, or Tobramycin, Colistin, Polymyxin B.Vancomycin, and Linezolid.
Pathogen-Specific Therapy: MRSA
- Vancomycin: Guidelines suggest maintaining AUC/MIC ≥ 400 for complicated S. aureus infections, loading dose 25-30 mg/kg (actual body weight) for seriously ill, maintenance doses 15-20 mg/kg (actual body weight) every 8 to 12 hours.
- Draw trough concentration at steady-state (5 x t1/2, usually before 4th dose).
- Target a trough concentration of 15-20 mg/L.
- Adverse effects: nephrotoxicity, ototoxicity, Red-Man Syndrome.
- Linezolid: 600 mg IV q12h.
- Drug-drug interactions with SSRIs, which increase risk for serotonin storm syndrome.
- Adverse effects: myelosuppression, serotonin syndrome.
- More expensive than vancomycin.
- Daptomycin: NEVER use for pneumonia because it is inactivated by surfactant.
- Limited evidence with teicoplanin, telavancin, ceftaroline, tedizolid.
Pathogen-Specific Therapy: Pseudomonas aeruginosa
- Perform Routine antimicrobial susceptibility testing to determine sensitivity to P. aeruginosa.
- If septic shock resolves or not at high risk for mortality, and susceptibility known: monotherapy is recommended.
- Monotherapy with aminoglycosides is NOT recommended.
- The patient is in In septic shock or at high risk for death, even if susceptibility known: combination therapy is recommended, and de-escalate to monotherapy if septic shock resolves.
Pathogen-Specific Therapy: Acinetobacter spp.
- Carbapenem or ampicillin/sulbactam if patient isolate susceptible to either.
- If only susceptible to polymyxins, IV polymyxin + adjunctive inhaled colistin; If only susceptible to colistin, use of rifampicin not recommended.
- Use of tigecycline is not recommended.
Pathogen-Specific Therapy: Carbapenem-resistant organisms
- If only susceptible to polymyxins, IV polymyxin + adjunctive inhaled colistin.
- Inhaled polymyxin B is not recommended due to lack of supporting clinical evidence.
Pathogen-Specific Therapy: Extended-spectrum Beta-lactamase (ESBL)—producing Gram-negative bacilli
- Consider allergies and comorbid conditions that increase the risk for side effects.
Other Treatment Strategies
- Newer drugs include Ceftazidime/avibactam, Ceftolozane/tazobactam, Meropenem/vaborbactam, and Imipenem/Cilastatin/Relebactam
- Older drugs include Colistin (colistimethate sodium) and Polymyxin B
- Inhaled antibiotics exist
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