An Evidence-Based Multidisciplinary Approach Focused on Creating Algorithms for Targeted Therapy of Infection-Related Ventilator-Associated Complications (IVACs) Caused by Pseudomonas aeruginosa and Acinetobacter baumannii in Critically Ill Adult Patients

• Published in: Antibiotics (Basel) Vol. 11; no. 1; p. 33
• Main Authors: Gatti, Milo, Viaggi, Bruno, Rossolini, Gian Maria, Pea, Federico, Viale, Pierluigi
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 28.12.2021; MDPI
• Subjects: Acinetobacter baumannii; Algorithms; Amides; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; antimicrobial stewardship; Cephalosporins; Colistin; Complications; Dosage; Drug dosages; Enzymes; Fosfomycin; infection-related ventilator-associated complications; Infections; Intensive care; Metallo-β-lactamase; Metallography; Mortality; multidisciplinary taskforce; Multidrug resistance; non-fermenting Gram-negative pathogens; Nosocomial infections; Optimization; Pathogens; Pharmacodynamics; Pharmacokinetics; Pharmacology; Piperacillin; PK/PD dosing optimization; Pneumonia; Pseudomonas aeruginosa; targeted antibiotic therapy; Tazobactam; Therapy; Ventilators; β Lactamase; β-Lactam antibiotics; targeted antibiotic therapy; multidisciplinary taskforce; antimicrobial stewardship; infection-related ventilator-associated complications; non-fermenting Gram-negative pathogens; PK/PD dosing optimization
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics11010033

(1) Background: To develop evidence-based algorithms for targeted antibiotic therapy of infection-related ventilator-associated complications (IVACs) caused by non-fermenting Gram-negative pathogens. (2) Methods: A multidisciplinary team of four experts had several rounds of assessments for developing algorithms devoted to targeted antimicrobial therapy of IVACs caused by two non-fermenting Gram-negative pathogens. A literature search was performed on PubMed-MEDLINE (until September 2021) to provide evidence for supporting therapeutic choices. Quality and strength of evidence was established according to a hierarchical scale of the study design. Six different algorithms with associated recommendations in terms of therapeutic choice and dosing optimization were suggested according to the susceptibility pattern of two non-fermenting Gram-negative pathogens: multi-susceptible Pseudomonas aeruginosa (PA), multidrug-resistant (MDR) metallo-beta-lactamase (MBL)-negative-PA, MBL-positive-PA, carbapenem-susceptible Acinetobacter baumannii (AB), and carbapenem-resistant AB. (3) Results: Piperacillin–tazobactam or fourth-generation cephalosporins represent the first therapeutic choice in IVACs caused by multi-susceptible PA. A carbapenem-sparing approach favouring the administration of novel beta-lactam/beta-lactamase inhibitors should be pursued in the management of MDR-MBL-negative PA infections. Cefiderocol should be used as first-line therapy for the management of IVACs caused by MBL-producing-PA or carbapenem-resistant AB. Fosfomycin-based combination therapy, as well as inhaled colistin, could be considered as a reasonable alternative for the management of IVACs due to MDR-PA and carbapenem-resistant AB. (4) Conclusions: The implementation of algorithms focused on prompt revision of antibiotic regimens guided by results of conventional and rapid diagnostic methodologies, appropriate place in therapy of novel beta-lactams, implementation of strategies for sparing the broadest-spectrum antibiotics, and pharmacokinetic/pharmacodynamic optimization of antibiotic dosing regimens is strongly suggested.