Therapy of Selected Pathogens in Nosocomial Pneumonia

Typically, ESBL-producing isolates of E. coli and K. pneumoniae are resistant to ceftazidime and aztreonam however, susceptibility testing may indicate that the organism is susceptible to other extended-spectrum P-lactams (cefo- 

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The ability to develop resistance when monotherapy (less often with aminoglycosides) is used to treat infections caused by P. aeruginosa is well described (17). Therefore, traditional therapy has consisted of a combination of an antipseudomonal P-lactam (or P-lactam/p-lactamase inhibitor, carbo-penem, monobactam) with an aminoglycoside because of in vitro demonstration of synergy however, critically ill patients have many risk factors that render them more susceptible to the nephrotoxicity of aminoglycosides. The 

Similar to cases with P. aeruginosa, nosocomial ventilator-associated pneumonia caused by Acinetobacter is associated with a high mortality rate. In a study of 48 patients (70), pneumonia caused by these two organisms have a mortality rate of 71.4% compared to other pathogens (40.7%), with the observation that this rate was in excess of that observed for the underlying disease however, the impact of antimicrobial therapy was not discussed. 

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