In which patients is a single antibiotic with activity against P aeruginosa contraindicated?

Updated: Apr 15, 2021
  • Author: Kartika Shetty, MD, FACP; Chief Editor: John L Brusch, MD, FACP  more...
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A single antibiotic with activity against P aeruginosa should be administered, except in patients with risk factors for multidrug-resistant (MDR) organisms, including the following:

  • Intravenous antibiotic use within the preceding 90 days
  • Septic shock or ARDS preceding VAP
  • Five or more days of hospitalization prior to VAP onset
  • Acute renal replacement therapy prior to the onset of VAP
  • The patient is located where more than 10% of gram-negative isolates are resistant
  • Patients in ICUs where antibiotic sensitivity rates are not available

Double-drug coverage of P aeruginosa should combine agents with a high degree of antipseudomonal activity and low resistance potential. Optimal combinations include piperacillin-tazobactam or a cephalosporin (cefepime, ceftazidime) or carbapenems (imipenem, meropenem) or aztreonam plus either a fluoroquinolone (levofloxacin, ciprofloxacin) or aminoglycoside (amikacin, gentamicin, tobramycin) or polymyxins (colistin, polymyxin B).

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