multi drug resistant Pseudomonas aeroginosa

[Nick8]

How can I treat a patient if he has P. aeroginisa resistant to any antibiotics?

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[jdh71]

How can I treat a patient if he has P. aeroginisa resistant to any antibiotics?

If I'm understanding you correctly . . . you have a PsA strain resistant to ALL antibiotics?

Pick a god.

Pray.

Good luck.

 

[Praziquantel86]

How can I treat a patient if he has P. aeroginisa resistant to any antibiotics?

Source control and/or family meetings.

 

[Nick8]

thank you for the answers.
But could I use antibiotics (for example Carbapems ) in high dosages to overcome this resistance? OR it wouldnt help in this situation?

 

[notamember82]

I've seen kpc respond to combo erta/dori.

 

[jdh71]

thank you for the answers.
But could I use antibiotics (for example Carbapems ) in high dosages to overcome this resistance? OR it wouldnt help in this situation?

If it's resistant it is probably resistant. Try what you can I suppose. It's about as good as picking a god at that point.

 

[Praziquantel86]

thank you for the answers.
But could I use antibiotics (for example Carbapems ) in high dosages to overcome this resistance? OR it wouldnt help in this situation?

Depends on the level of resistance. Pan-resistant Pseudomonas often has multiple acquired mechanisms of resistance that overlap (e.g., down-regulated porins and over expressed efflux pumps), leading to high-level resistance to everything. In the even that a beta-lactam remains moderately sensitive, you can try for pharmacodynamic optimization. It may work, most likely won't though.

 

[core0]

How can I treat a patient if he has P. aeroginisa resistant to any antibiotics?

First of all make sure its really pan-resistant. Especially at academic centers, the micro lab frequently censors certain antibiotic resistances so that providers don't use those antibiotics. Usually ID can see those results. The other issue is to have the lab drop disks less common antibiotics.

Finally you can sometimes treat intermediate resistances. We treated a pan resistant Pseudomonas with inhaled and IV Colistin based on the MIC. Also look at continuous antibiotic infusion. This can sometimes overcome MIC:
http://www.hopkinsmedicine.org/amp/includes/Continuous_and_Extended_Infusion_Beta_lactams.pdf

Talk to ID and your clinical pharmacist

 

[Nick8]

Thank you for the useful answers!

 

[JoBreeze]

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[Bostonredsox]

IV Colistin makes me piss my pants. It's like giving pts gasoline. Might as well put In There permcath while your infusing it and start the renal diet....