Pina-Sánchez Manuel, Rua Marta, López-Causapé Carla, Bilbao Idoia, Sastre-Femenia Miquel Àngel, Oliver Antonio, Del Pozo José Luis
Service of Clinical Microbiology, Clínica Universidad de Navarra, Av. De Pio XII, 36, Pamplona, Navarre, 31008, Spain.
Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain.
J Antimicrob Chemother. 2025 May 2;80(5):1371-1376. doi: 10.1093/jac/dkaf083.
Few active antibiotic options are available to treat MBL-producing Pseudomonas aeruginosa infections, and some of these options are either poorly tolerated or have pharmacokinetic limitations. The use of aztreonam monotherapy for treating MBL-producing P. aeruginosa remains controversial due to the risk of selecting resistant mutants during treatment.
To describe the clinical outcomes of patients treated with ceftazidime-avibactam plus aztreonam for VIM-producing P. aeruginosa infections. The assessed outcomes include clinical success, clinical cure, all-cause mortality at day 28, combination therapy-associated adverse events, infection relapse and microbiological recurrence.
This retrospective observational single-centre study was conducted at Clínica Universidad de Navarra, Pamplona, Spain. Eight patients with VIM-producing P. aeruginosa infections were included. Whole-genome sequencing of isolates was performed at Hospital Universitario Son Espases, Palma, Spain.
All isolates were susceptible to aztreonam and aztreonam-avibactam. No resistance mechanisms against these antibiotics were identified through whole-genome sequencing, except in one isolate that overexpressed the MexAB-OprM efflux pump. Clinical success and clinical cure were achieved in seven of eight patients, while all-cause mortality at day 28 was two of eight. Clinical cure was documented for five different infections and three distinct P. aeruginosa clones. No adverse events related to antibiotic therapy were reported, and no infection relapses occurred after treatment. Microbiological recurrence was observed in two cases.
In our experience, patients with VIM-producing P. aeruginosa infections treated with ceftazidime-avibactam plus aztreonam mostly achieved clinical success. However, given the limited sample size, further research is required to validate these findings.
治疗产金属β-内酰胺酶（MBL）的铜绿假单胞菌感染的有效抗生素选择很少，其中一些选择耐受性差或存在药代动力学限制。由于在治疗过程中存在选择耐药突变体的风险，使用氨曲南单药治疗产MBL的铜绿假单胞菌仍存在争议。
描述用头孢他啶-阿维巴坦联合氨曲南治疗产VIM型铜绿假单胞菌感染患者的临床结局。评估的结局包括临床成功、临床治愈、第28天的全因死亡率、联合治疗相关不良事件、感染复发和微生物学复发。
这项回顾性观察性单中心研究在西班牙潘普洛纳的纳瓦拉大学诊所进行。纳入了8例产VIM型铜绿假单胞菌感染患者。分离株的全基因组测序在西班牙帕尔马的Son Espases大学医院进行。
所有分离株均对氨曲南和氨曲南-阿维巴坦敏感。通过全基因组测序未发现对这些抗生素的耐药机制，只有一株分离株过表达MexAB-OprM外排泵。8例患者中有7例获得临床成功和临床治愈，而第28天的全因死亡率为8例中的2例。记录了5种不同感染和3个不同铜绿假单胞菌克隆的临床治愈情况。未报告与抗生素治疗相关的不良事件，治疗后未发生感染复发。2例观察到微生物学复发。
根据我们的经验，用头孢他啶-阿维巴坦联合氨曲南治疗产VIM型铜绿假单胞菌感染的患者大多取得了临床成功。然而，鉴于样本量有限，需要进一步研究来验证这些发现。
