What are the treatment options for Pseudomonas cardiovascular (CV) infections?

Updated: Dec 17, 2018
  • Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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Answer

Cardiovascular (CV) and respiratory infections

  • To treat endocarditis, administer an antipseudomonal beta-lactam with high-dose aminoglycoside for approximately 6 weeks.

  • According to the criteria used in France to select antibiotics to treat VAP, the following 2 risk factors must be considered: (1) administration of broad-spectrum antibiotics in the previous 15 days and (2) mechanical ventilation for fewer than 7 days or for 7 or more days. The extended factors predict the involvement of multiresistant nosocomial P aeruginosa, suggesting administration of carbapenems to those who have undergone mechanical ventilation of 7 or more days and who have been exposed to antibiotics in the prior 15 days.

  • The role of antibiotic prophylaxis or chronic suppression of respiratory pseudomonal infections in patients with CF is controversial. Among the promising treatment plans are intermittent aerosolization of antibiotics to patients with CF who have established pseudomonal lung infections.

  • Choices for empiric antibiotic treatment in patients with a history of Pseudomonas infection requires review of previous culture sensitivity.

  • More widely accepted is the treatment of children with pseudomonal infections by using fluoroquinolone, especially children with previous therapeutic failure or resistance to multiple other antibiotics. [10] Treatment often continues until symptoms resolve (ie, 1-2 wk).

  • Inhalation of mucolytic and hydrating agents, postural drainage, and chest physiotherapy often are therapies used together. Bronchial lavage also has been used to remove respiratory secretions.

  • A Cochrane review looked at 60 clinical trials to examine the effectiveness of antibiotic treatment in cystic fibrosis patients with early Pseudomonas aeruginosa infection. The study concluded that nebulized antibiotics by themselves or along with oral antibiotics were better than no treatment at all and that infection may be eradicated for up to two years. However, there is insufficient evidence that antibiotic treatment decreases mortality and morbidity or improves quality of life. [11]


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