{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,23]],"date-time":"2026-09-23T11:23:20Z","timestamp":1790162600645,"version":"4.1.0"},"reference-count":17,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2018,1,16]],"date-time":"2018-01-16T00:00:00Z","timestamp":1516060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Microorganisms"],"abstract":"<jats:p>It is unknown as to whether other beta-lactams can be used for bloodstream infections (BSI) resulting from Pseudomonas aeruginosa (PA) which are non-susceptible to one or more carbapenem. We conducted a retrospective cohort study at the Assaf Harofeh Medical Center (AHMC) from January 2010 to August 2014. Adult patients with PA-BSI non-susceptible to a group 2 carbapenem but susceptible to ceftazidime or piperacillin (with or without tazobactam), were enrolled. We compared the outcomes of patients who received an appropriate beta-lactam antibiotic (\u201ccases\u201d) to those who received an appropriate non-beta-lactam antibiotic (\u201ccontrols\u201d). Whole genome sequencing was performed for one of the isolates. Twenty-six patients with PA-BSI met inclusion criteria: 18 received a beta-lactam and 8 a non-beta-lactam (three a fluoroquinolone, two colistin, one a fluoroquinolone and an aminoglycoside, one a fluoroquinolone and colistin, and one colistin and an aminoglycoside). All clinical outcomes were similar between the groups. There were large variations in the phenotypic susceptibilities of the strains. A detailed molecular investigation of one isolate revealed a strain that belonged to MLST-137, with the presence of multiple efflux pumps, OXA-50, and a chromosomally mediated Pseudomonas-derived cephalosporinase (PDC). The oprD gene was intact. Non-carbapenem-\u03b2-lactams may still be effective alternatives for short duration therapy (up to 14 days) for BSI caused by a carbapenem non-susceptible (but susceptible to ceftazidime, piperacillin, and\/or piperacillin-tazobactam) PA strain. This observation requires further confirmatory analyses. Future molecular investigations should be performed, in order to further analyze additional potential mechanisms for this prevalent phenotype.<\/jats:p>","DOI":"10.3390\/microorganisms6010009","type":"journal-article","created":{"date-parts":[[2018,1,17]],"date-time":"2018-01-17T04:23:44Z","timestamp":1516163024000},"page":"9","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Therapeutic Management of Pseudomonas aeruginosa Bloodstream Infection Non-Susceptible to Carbapenems but Susceptible to \u201cOld\u201d Cephalosporins and\/or to Penicillins"],"prefix":"10.3390","volume":"6","author":[{"given":"Ronit","family":"Zaidenstein","sequence":"first","affiliation":[{"name":"Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel"},{"name":"Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asaf","family":"Miller","sequence":"additional","affiliation":[{"name":"Intensive-Care Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruthy","family":"Tal-Jasper","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hadas","family":"Ofer-Friedman","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menachem","family":"Sklarz","sequence":"additional","affiliation":[{"name":"Bioinformatics Unit, National Institute for Biotechnology in the Negev, Beer-Sheva 84105, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Katz","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Shaare Zedek Medical Center, Hebrew-University, Hadassah Medical School, Jerusalem 91031, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsillia","family":"Lazarovitch","sequence":"additional","affiliation":[{"name":"Clinical Microbiology Laboratory, Assaf Harofeh Medical Center, Zerifin 70300, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Lephart","sequence":"additional","affiliation":[{"name":"Department of University Laboratories, Detroit Medical Center, Detroit, MI 48201, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bethlehem","family":"Mengesha","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oran","family":"Tzuman","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mor","family":"Dadon","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chen","family":"Daniel","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Moran-Gilad","sequence":"additional","affiliation":[{"name":"Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel"},{"name":"Public Health Services, Ministry of Health, Jerusalem 91010, Israel"},{"name":"ESCMID Study Group for Genomic and Molecular Diagnostics (ESGMD), 214 4010 Basel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dror","family":"Marchaim","sequence":"additional","affiliation":[{"name":"Unit of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel"},{"name":"Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2018,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.1586\/14787210.2015.1064310","article-title":"Prevalence and risk factors associated with colonization and infection of extensively drug-resistant Pseudomonas aeruginosa: A systematic review","volume":"13","author":"Buhl","year":"2015","journal-title":"Expert Rev. Anti-Infect. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1086\/595011","article-title":"Bad bugs, no drugs: No ESKAPE! An update from the Infectious Diseases Society of America","volume":"48","author":"Boucher","year":"2009","journal-title":"Clin. Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1804","DOI":"10.1056\/NEJMra0904124","article-title":"Hospital-acquired infections due to gram-negative bacteria","volume":"362","author":"Peleg","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1086\/504477","article-title":"Mechanisms of multidrug resistance in Acinetobacter species and Pseudomonas aeruginosa","volume":"43","author":"Bonomo","year":"2006","journal-title":"Clin. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1086\/421946","article-title":"Nosocomial bloodstream infections in US hospitals: Analysis of 24,179 cases from a prospective nationwide surveillance study","volume":"39","author":"Wisplinghoff","year":"2004","journal-title":"Clin. Infect. Dis."},{"key":"ref_6","unstructured":"Centers for Disease Control and Prevention (CDC) (2012). Pseudomonas aeruginosa respiratory tract infections associated with contaminated ultrasound gel used for transesophageal echocardiography-Michigan, December 2011\u2013January 2012. MMWR Morb. Mortal. Wkly. Rep., 61, 262\u2013264."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1002\/phar.1636","article-title":"Infections Caused by Resistant Gram-Negative Bacteria: Epidemiology and Management","volume":"35","author":"Kaye","year":"2015","journal-title":"Pharmacotherapy"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)","volume":"315","author":"Singer","year":"2016","journal-title":"JAMA"},{"key":"ref_9","unstructured":"CLSI (Clinical and Laboratory Standards Institute) (2015). Performance Standards for Antimibrobial Susceptibility Testing, Clinical and Laboratory Standards Institute. Nineteenth informational supplement; Approved Standard M100-S25."},{"key":"ref_10","unstructured":"(2017, January 01). Pseudomonas aeruginosa MLST Database. Available online: http:\/\/pubmlst.org\/paeruginosa\/."},{"key":"ref_11","unstructured":"(2017, January 01). The Comprehensive Antibiotic Resistance Database. Available online: https:\/\/card.mcmaster.ca\/."},{"key":"ref_12","unstructured":"(2017, January 01). Center for Genomic Epidemiology. Available online: https:\/\/cge.cbs.dtu.dk\/services\/ResFinder\/."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"4388","DOI":"10.1128\/JCM.02782-14","article-title":"A novel Pseudomonas aeruginosa strain with an oprD mutation in relation to a nosocomial respiratory infection outbreak in an intensive care unit","volume":"52","author":"Yan","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"ref_14","unstructured":"(2017, January 01). Bioinformatics Core Facility. Available online: http:\/\/bioinfo.bgu.ac.il\/genomes\/SPICE\/19.Single_Pseudomonas."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1766","DOI":"10.1128\/AAC.01410-08","article-title":"Extended-spectrum cephalosporinases in Pseudomonas aeruginosa","volume":"53","author":"Poirel","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2043","DOI":"10.1128\/AAC.48.6.2043-2048.2004","article-title":"Biochemical characterization of the naturally occurring oxacillinase OXA-50 of Pseudomonas aeruginosa","volume":"48","author":"Girlich","year":"2004","journal-title":"Antimicrob Agents Chemother."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/01.qco.0000171920.44809.f0","article-title":"Update on Pseudomonas aeruginosa and Acinetobacter baumannii infections in the healthcare setting","volume":"18","author":"Carmeli","year":"2005","journal-title":"Curr. Opin. Infect. Dis."}],"container-title":["Microorganisms"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-2607\/6\/1\/9\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T14:51:24Z","timestamp":1760194284000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-2607\/6\/1\/9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,1,16]]},"references-count":17,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2018,3]]}},"alternative-id":["microorganisms6010009"],"URL":"https:\/\/doi.org\/10.3390\/microorganisms6010009","relation":{},"ISSN":["2076-2607"],"issn-type":[{"value":"2076-2607","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,1,16]]}}}