Response

Abstract

We appreciate the correspondence of Dr Kashiura et al regarding our recent publication on Community-Acquired Pneumonia due to Multidrug and non-Multidrug Resistant Pseudomonas aeruginosa published in CHEST (August 2016).1Cillóniz C. Gabarrús A. Ferrer M. et al.Community-acquired pneumonia due to multidrug- and non–multidrug resistant pseudomonas aeruginosa.Chest. 2016; 150: 415-425Abstract Full Text Full Text PDF PubMed Scopus (69) Google Scholar Kashiura et al raise concerns that for P aeruginosa infection, initial appropriate empirical treatment requires two antibiotics. In response to their comments, our definition was based on the recommendations of the 2007 American Thoracic Society/Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines and on our previous study.2Arancibia F. Bauer T.T. Ewig S. et al.Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis.Arch Intern Med. 2002; 162: 1849-1858Crossref PubMed Scopus (318) Google Scholar Regarding to the debate surrounding whether to use combination therapy or monotherapy for P aeruginosa CAP, the reason for recommending combination therapy is the possibility of multidrug-resistant (MDR) P aeruginosa infection. We would simply like to point out that our study population included immunocompetent patients with CAP, unlike the studies mentioned3Kim Y.J. Jun Y.H. Kim Y.R. et al.Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia; retrospective study of impact of combination antimicrobial therapy.BMC Infect Dis. 2014; 14: 161Crossref PubMed Scopus (69) Google Scholar, 4Traugott K.A. Echevarria K. Maxwell P. Green K. Lewis J.S. Monotherapy or combination therapy? The Pseudomonas aeruginosa conundrum.Pharmacotherapy. 2011; 31: 598-608Crossref PubMed Scopus (66) Google Scholar by Dr Kashiura et al, which had a heterogeneous population, including immunosuppressed patients. We believe that future research may identify which specific population may benefit from combination therapy. The incidence of MDR P aeruginosa has increased in our institution in recent years and is now more frequent than it was before 2000. In this context, the probability of MDR P aeruginosa infection is high, and it will be useful for clinicians to use previous antibiotic therapy as a risk factor for MDR P aeruginosa, as mentioned in the article.Notice of annual meeting of fellowsThe Annual Meeting of Fellows of CHEST will convene at 10:45 am PT, Sunday, October 23, 2016, at the Los Angeles Convention Center, Room 404AB, in Los Angeles, California, to elect CHEST Officers, Regents, and Global Governors to hold office for the following year, to receive reports, and to transact such other business as shall properly come before the meeting. The Annual Meeting of Fellows of CHEST will convene at 10:45 am PT, Sunday, October 23, 2016, at the Los Angeles Convention Center, Room 404AB, in Los Angeles, California, to elect CHEST Officers, Regents, and Global Governors to hold office for the following year, to receive reports, and to transact such other business as shall properly come before the meeting. Community-Acquired Pneumonia Due to Multidrug- and Non–Multidrug-Resistant Pseudomonas aeruginosaCHESTVol. 150Issue 2PreviewPseudomonas aeruginosa is not a frequent pathogen in community-acquired pneumonia (CAP). However, in patients with severe CAP, P aeruginosa can be the etiology in 1.8% to 8.3% of patients, with a case-fatality rate of 50% to 100%. We describe the prevalence, clinical characteristics, outcomes, and risk factors associated with CAP resulting from multidrug-resistant (MDR) and non-MDR P aeruginosa. Full-Text PDF What Is the Appropriate Therapy for Community-Acquired Pseudomonas Aeruginosa Pneumonia?CHESTVol. 150Issue 3PreviewWe read with great interest the recent article published by Cillóniz et al1 in CHEST (August 2016), a descriptive and exploratory study about community-acquired pneumonia (CAP) due to Pseudomonas aeruginosa. The authors reported that 64% of cases of P aeruginosa CAP received inappropriate empirical therapy. Moreover, P aeruginosa and inappropriate empirical treatment are independent risk factors associated with mortality in CAP. However, we would like to raise two points of concern. Full-Text PDF