Abstract
In vitro synergy testing using levofloxacin (LVX) plus piperacillin/tazobactam (TZP) was performed by Etest and time-kill assay (TKA) for 31 unique fluoroquinolone-resistant Pseudomonas aeruginosa isolates. The Etest method showed synergy for 9/31 (29%) of isolates, while TKA showed synergy with 14/31 (45%) of isolates. When comparing the Etest method and TKA, concordant results for synergy, antagonism, and indifference were obtained for 24/31 (77%) of the isolates tested.
Highlights
Pseudomonas aeruginosa is a major nosocomial pathogen, and effective therapy represents a great challenge
P. aeruginosa strains are often resistant to antibacterial agents from different classes, including β-lactams, aminoglycosides, and fluoroquinolones; some strains are only susceptible to polymyxins [1]
Treatment of P. aeruginosa involves a combination of antibacterial agents
Summary
Pseudomonas aeruginosa is a major nosocomial pathogen, and effective therapy represents a great challenge. P. aeruginosa strains are often resistant to antibacterial agents from different classes, including β-lactams, aminoglycosides, and fluoroquinolones; some strains are only susceptible to polymyxins [1]. The mechanisms of resistance of P. aeruginosa are determined by both chromosomal and plasmid genes encoding different resistance enzymes (β-lactamases, including extended spectrum β-lactamases, carbapenemases, etc.); other mechanisms include decreased bacterial wall permeability, target alterations, and active drug efflux [2]. Treatment of P. aeruginosa involves a combination of antibacterial agents. A recent retrospective cohort study demonstrated a reduction in 28-day all-cause mortality in less severely ill patients (533 of 702 patients, (75.9%)) with monomicrobial bacteremia due to aerobic gram-negative bacilli (including P. aeruginosa) who received either a combination of a β-lactam plus LVX or ciprofloxacin versus β-lactam monotherapy [3]
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