The control of multidrug-resistant pseudomonas: Insights into epidemiology and management

Abstract

Multidrug-resistant (MDR) Pseudomonas aeruginosa has emerged as a nosocomial pathogen. It is the third most common cause of invasive infections in the Intensive Care Unit (ICU) and the second most common cause of health-care associated pneumonia. Epidemiological studies reveal that the acquisition of these isolates may be either endogenous in 55% of cases or exogenous in 45% of cases. Endogenous acquisition results from the effect of prior administration of antimicrobials on bacterial flora, namely fluoroquinolones and carbapenems. Exogenous acquisition results after cross-transmission from a common environmental source. Available therapeutic options for the management of infections by MDR P. aeruginosa are limited to the administration of polymyxins. Limitation of spread of these isolates relies on the combination of several strategies consisting of rotation of empirically prescribed antimicrobials, early recognition and containment of outbreaks and isolation of contaminated patients.