Approach to managing Pseudomonas aeruginosa bloodstream infections

For Pseudomonas aeruginosa bloodstream infections, the choice between monotherapy and combination therapy depends on the severity of the infection and whether susceptibilities are known.

For Pseudomonas aeruginosa sepsis or septic shock, combination therapy with 2 antipseudomonal drugs is recommended until the results of susceptibility testing are available. Once susceptibility is known, combination therapy is usually not required, but may be used for septic shock or infections with a high organism burden – seek expert advice. If monotherapy is used, an aminoglycoside (gentamicin or tobramycin) is not recommended unless appropriate alternative drugs are not available; clinical outcomes may be inferior with an aminoglycoside compared to therapy with an antipseudomonal beta-lactam antibiotic (cefepime, ceftazidime, piperacillin+tazobactam).

For Pseudomonas aeruginosa bacteraemia without sepsis or septic shock, monotherapy with an antipseudomonal beta-lactam antibiotic is recommended until the results of susceptibility testing are available.

For advice on managing patients with febrile neutropenia caused by P. aeruginosa bacteraemia, see Febrile neutropenia.