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Extensively drug-resistant Pseudomonas aeruginosa: clinical features and treatment with Ceftazidime-Avibactam and Ceftolozane-Tazobactam in a tertiary care university hospital center in Portugal: a cross-sectional and retrospective observational study

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dc.contributor.authorPedro, Diogo
dc.contributor.authorPaulo, Sérgio
dc.contributor.authorMimoso Santos, Carla
dc.contributor.authorFonseca, Ana Bruschy
dc.contributor.authorCristino, José Melo
dc.contributor.authorAyres Pereira, Álvaro
dc.contributor.authorCaneiras, Catia
dc.date.accessioned2024-03-20T14:39:12Z
dc.date.available2024-03-20T14:39:12Z
dc.date.issued2024
dc.descriptionCopyright © 2024 Mendes Pedro, Paulo, Santos, Fonseca, Melo Cristino, Pereira and Caneiras. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.pt_PT
dc.description.abstractIntroduction: Extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) is a growing concern due to its increasing incidence, limited therapeutic options, limited data on the optimal treatment, and high mortality rates. The study aimed to characterize the population, the outcome and the microbiological characteristics of XDR-PA identified in a Portuguese university hospital center. Methods: All XDR-PA isolates between January 2019 and December 2021 were identified. XDR-PA was defined as resistance to piperacillin-tazobactam, third and fourth generation cephalosporins, carbapenems, aminoglycosides and fluoroquinolones. A retrospective analysis of the medical records was performed. Results: One hundred seventy-eight individual episodes among 130 patients with XDR-PA detection were identified. The most common sources of infection were respiratory (32%) and urinary tracts (30%), although skin and soft tissue infections (18%) and primary bacteremia (14%) were also prevalent. Colonization was admitted in 64 cases. Several patients had risk factors for complicated infections, most notably immunosuppression, structural lung abnormalities, major surgery, hemodialysis or foreign intravascular or urinary devices. XDR-PA identification was more frequent in male patients with an average age of 64.3 ± 17.5 years. One non-susceptibility to colistin was reported. Only 12.4% were susceptible to aztreonam. Ceftazidime-avibactam (CZA) was susceptible in 71.5% of the tested isolates. Ceftolozane-tazobactam (C/T) was susceptible in 77.5% of the tested isolates. Antibiotic regimens with XDR-PA coverage were reserved for patients with declared infection, except to cystic fibrosis. The most frequently administered antibiotics were colistin (41 cases), CZA (39 cases), and C/T (16 cases). When combination therapy was used, CZA plus colistin was preferred. The global mortality rate among infected patients was 35.1%, significantly higher in those with hematologic malignancy (50.0%, p < 0.05), followed by the ones with bacteremia (44.4%, p < 0.05) and those medicated with colistin (39.0%, p < 0.05), especially the ones with respiratory infections (60.0%). Among patients treated with CZA or C/T, the mortality rate seemed to be lower. Discussion: XDR-PA infections can be severe and difficult to treat, with a high mortality rate. Even though colistin seems to be a viable option, it is likely less safe and efficient than CZA and C/T. To the best of the authors' knowledge, this is the first description of the clinical infection characteristics and treatment of XDR-PA in Portugal.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationFront Microbiol. 2024 Feb 13:15:1347521pt_PT
dc.identifier.doi10.3389/fmicb.2024.1347521pt_PT
dc.identifier.eissn1664-302X
dc.identifier.urihttp://hdl.handle.net/10451/63598
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherFrontierspt_PT
dc.relation.publisherversionhttps://www.frontiersin.org/journals/microbiologypt_PT
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/pt_PT
dc.subjectPseudomonas aeruginosapt_PT
dc.subjectAntimicrobial resistancept_PT
dc.subjectCeftazidime-Avibactampt_PT
dc.subjectCeftolozane-Tazobactampt_PT
dc.subjectDifficult-to-treat infectionspt_PT
dc.subjectExtensively drug-resistantpt_PT
dc.titleExtensively drug-resistant Pseudomonas aeruginosa: clinical features and treatment with Ceftazidime-Avibactam and Ceftolozane-Tazobactam in a tertiary care university hospital center in Portugal: a cross-sectional and retrospective observational studypt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.titleFrontiers in Microbiologypt_PT
oaire.citation.volume15pt_PT
person.familyNameFreire Leitão Duarte Mendes Pedro
person.familyNamePaulo
person.familyNameMimoso Santos
person.familyNameMelo Cristino
person.familyNameSendim Aires Pereira
person.familyNameCaneiras
person.givenNameDiogo Miguel
person.givenNameSérgio
person.givenNameCarla
person.givenNameJosé
person.givenNameÁlvaro
person.givenNameCatia
person.identifier.ciencia-id8B1F-4D7E-52CD
person.identifier.ciencia-id871E-6AD6-F37C
person.identifier.ciencia-id9A12-BAA9-F8AC
person.identifier.ciencia-id5217-449F-3B4F
person.identifier.orcid0000-0002-4923-2940
person.identifier.orcid0009-0008-4132-9079
person.identifier.orcid0000-0002-7067-505X
person.identifier.orcid0000-0001-8643-1722
person.identifier.orcid0000-0002-3735-8554
person.identifier.ridH-3726-2013
person.identifier.scopus-author-id7004053640
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication5e692303-0446-4c4d-a887-ab82c7dc0186
relation.isAuthorOfPublication34ad3982-45e9-4a25-8a7c-3a452138f1b8
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relation.isAuthorOfPublicationacefbfd7-46d0-4429-80b1-ad159fe4ca95
relation.isAuthorOfPublication12912724-e1d6-4213-a0b9-26a44b3f95bc
relation.isAuthorOfPublication67e72892-1980-4138-aeeb-244c4222d335
relation.isAuthorOfPublication.latestForDiscoveryacefbfd7-46d0-4429-80b1-ad159fe4ca95

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