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Catia Cillóniz, PhD; Antoni Torres, MD
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FINANCIAL/NONFINANCIAL DISCLOSURES: See earlier cited article for author conflicts of interest.

Department of Pneumology, Institut Clinic del Tórax, Hospital Clinic of Barcelona - Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona (UB) - SGR 911- Ciber de Enfermedades Respiratorias (Ciberes), Barcelona, Spain

CORRESPONDING AUTHOR: Antoni Torres, MD, Department of Pneumology, Hospital Clinic of Barcelona, Spain, c/ Villarroel 170, 08036 Barcelona, Spain


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


Chest. 2016;150(3):757. doi:10.1016/j.chest.2016.06.039
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We appreciate the correspondence of Dr Kashiura et al regarding our recent publication on Community-Acquired Pneumonia due to Multidrug and non-Multidrug Resistant Pseudomonas aeruginosa published in CHEST (August 2016). Kashiura et al raise concerns that for P aeruginosa infection, initial appropriate empirical treatment requires two antibiotics. In response to their comments, our definition was based on the recommendations of the 2007 American Thoracic Society/Infectious Diseases Society of America community-acquired pneumonia (CAP) guidelines and on our previous study. Regarding to the debate surrounding whether to use combination therapy or monotherapy for P aeruginosa CAP, the reason for recommending combination therapy is the possibility of multidrug-resistant (MDR) P aeruginosa infection. We would simply like to point out that our study population included immunocompetent patients with CAP, unlike the studies mentioned, by Dr Kashiura et al, which had a heterogeneous population, including immunosuppressed patients. We believe that future research may identify which specific population may benefit from combination therapy.

The incidence of MDR P aeruginosa has increased in our institution in recent years and is now more frequent than it was before 2000. In this context, the probability of MDR P aeruginosa infection is high, and it will be useful for clinicians to use previous antibiotic therapy as a risk factor for MDR P aeruginosa, as mentioned in the article.

The Annual Meeting of Fellows of CHEST will convene at 10:45 am PT, Sunday, October 23, 2016, at the Los Angeles Convention Center, Room 404AB, in Los Angeles, California, to elect CHEST Officers, Regents, and Global Governors to hold office for the following year, to receive reports, and to transact such other business as shall properly come before the meeting.

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]
 
Arancibia F. .Bauer T.T. .Ewig S. .et al Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med. 2002;162:1849-1858 [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]
 
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]
 

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Tables

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]
 
Arancibia F. .Bauer T.T. .Ewig S. .et al Community-acquired pneumonia due to gram-negative bacteria and pseudomonas aeruginosa: incidence, risk, and prognosis. Arch Intern Med. 2002;162:1849-1858 [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]
 
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]
 
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