LAB WORK

• Gram (-), non-fermenter, oxidase (-)

TREATMENT OPTIONS

• Carbapenems
  • DO NOT USE ERTAPENEM
  • Susceptibility to meropenem DOES NOT predict susceptiblity to imipenem or doripenem (or vice versa), different resistance mechanisms
• Unasyn
  • Sulbactam is the agent with activity, not ampicillin
• Polymyxin B, Polymyxin E (Colistin)
  • Reserved as last option against MDR strains
  • Polymyxin B more favorable PK/PD over colistin
  • Use loading doses
• Aminoglycosides
  • Tobramycin and amikacin more active than gentamicin
  • Usually used in combo with another active agent, not recommended as monotherapy for severe infections
• Tigecycline and Tetracyclines
  • Doxycycline and minocycline more active than tetracycline
  • Tetracycline sensitivity DOES NOT indicate minocycline or doxycycline sensitivity
• Other agents such as anti-pseudomonal cephalosporins, anti-pseudomonal penicillins, aztreonam, Bactrim, or fluoroquinolones can still be used if cultures confirm sensitivity

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CLINICAL NOTES

• Able to acquire resistance to multiple antibiotics faster than other gram negative organisms
• Combination therapy
  • Conflicting results, even for same agents being tested
  • Some experts favor colistin + carbapenem combination
• Respiratory tract infections are most common site
• Bacteremia second most common site
  • Vascular catheters and respiratory tract most common source
• May also be implicated in skin/soft tissue infections (indwelling catheters, wounds, burns, incisions), genitourinary (but rarely invasive), and rarely meningitis, endocarditis, osteomyelitis, endopthalmitis, or liver/pancreatic abscess
• May be a contaminant occasionally (colonizes skin, wounds, respiratory tract, GI tract)