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Correspondence |

What Is the Appropriate Therapy for Community-Acquired Pseudomonas Aeruginosa Pneumonia? FREE TO VIEW

Masahiro Kashiura, MD; Yukihiro Kitamura, MD; Tomoko Sakatani, MD; Toshinobu Yamagishi, MD
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FINANCIAL/NONFINANCIAL DISCLOSURES: None declared.

Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan

CORRESPONDENCE TO: Masahiro Kashiura, MD, Tertiary Emergency Medical Center, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo 130-8575, Japan


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;150(3):756-757. doi:10.1016/j.chest.2016.06.038
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Published online

We read with great interest the recent article published by Cillóniz et al in CHEST (August 2016), a descriptive and exploratory study about community-acquired pneumonia (CAP) due to Pseudomonas aeruginosa. The authors reported that 64% of cases of P aeruginosa CAP received inappropriate empirical therapy. Moreover, P aeruginosa and inappropriate empirical treatment are independent risk factors associated with mortality in CAP. However, we would like to raise two points of concern.

First, Cillóniz et al defined combination antimicrobial therapy as being appropriate therapy for P aeruginosa CAP, unlike CAP caused by other pathogens. However, monotherapy is the usual empirical treatment of CAP. Hence, empirical therapy instituted in cases of P aeruginosa CAP is necessarily classified as inappropriate. Furthermore, it is controversial whether combination therapy has a significant effect on the outcome of P aeruginosa CAP compared with monotherapy., This may have led to an overestimation of the results reported by the present study.

Second, we would like to know the cumulative antibiogram of P aeruginosa in their local context, as this is paramount in deciding on empirical antibiotic selection.

References

Cillóniz C. .Gabarrús A. .Ferrer M. .et al Community-acquired pneumonia due to multidrug- and non–multidrug resistant pseudomonas aeruginosa. Chest. 2016;150:415-425 [PubMed]journal. [CrossRef] [PubMed]
 
Mandell L.A. .Wunderink R.G. .Anzueto A. .et al Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72 [PubMed]journal. [CrossRef] [PubMed]
 
Traugott K.A. .Echevarria K. .Maxwell P. .Green K. .Lewis J.S. . Monotherapy or combination therapy? The Pseudomonas aeruginosa conundrum. Pharmacotherapy. 2011;31:598-608 [PubMed]journal. [CrossRef] [PubMed]
 
Kim Y.J. .Jun Y.H. .Kim Y.R. .et al Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia; retrospective study of impact of combination antimicrobial therapy. BMC Infect Dis. 2014;14:161- [PubMed]journal. [CrossRef] [PubMed]
 

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References

Cillóniz C. .Gabarrús A. .Ferrer M. .et al Community-acquired pneumonia due to multidrug- and non–multidrug resistant pseudomonas aeruginosa. Chest. 2016;150:415-425 [PubMed]journal. [CrossRef] [PubMed]
 
Mandell L.A. .Wunderink R.G. .Anzueto A. .et al Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44:S27-S72 [PubMed]journal. [CrossRef] [PubMed]
 
Traugott K.A. .Echevarria K. .Maxwell P. .Green K. .Lewis J.S. . Monotherapy or combination therapy? The Pseudomonas aeruginosa conundrum. Pharmacotherapy. 2011;31:598-608 [PubMed]journal. [CrossRef] [PubMed]
 
Kim Y.J. .Jun Y.H. .Kim Y.R. .et al Risk factors for mortality in patients with Pseudomonas aeruginosa bacteremia; retrospective study of impact of combination antimicrobial therapy. BMC Infect Dis. 2014;14:161- [PubMed]journal. [CrossRef] [PubMed]
 
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