4MRGN and regular i.v. therapie

Question

Hello,
for about one and a half years besides a "normal" Pseudomonas aeruginosa also a 4MRGN is detected in my sputum. According to the lab, it is though still sensible to 1 or 2 antbiotics. My question is now, if regular i.v. therapies (like they are desired by the treating physician) make sense in this case or if one creates a complete resistance by this.
Shortly data about my person: I am 21 years old and have always been in a good general health condition. However, in autumn last year, the middle lobe has been removed due to constant inflammation, that caused problems in the two preceding years. The FEV1 value is actually at 60% and did not change in comparison to the time before the operation. Since the operation, I did not have an infection, pneumonia or others and I visit the fitness studio 2-3 times a week.
Best regards,

Answer

Hello,
the definiton 4MRGN (multiresistant, gram-negative) is still relatively new and means the resistance against at least 4 antibiotic-classes, besides there are still 3MRGN with resistance against 3 antibiotic-groups. This definition does not mean, that the tested antibiotic drugs are also not effective in the body, because we know, that the resistance testing is not identical with the effect of the antibiotics in the body. Therefore antibiotics can still be effective as an i.v. therapy, even if the testing revealed a resistance.
For this reason it is indeed sensible, to give also antibiotics in the frame of an i.v. therapy, that have been tested to be resistant. The risk, that later on more strains are tested to be resistant in the antibiogram, is indeed there. In spite of this, it is not necessarily so, that nothing is possible anymore then.
If a waiting strategy is justified in your special case, should not be decided dependent on the resistance pattern in my opinion, but dependent on the overall course (lung function, frequency of infections) and should be decided accordingly.
In the meantime there is namely indeed the opinion, that one could totally forget about a resitance testing.
Best regards,
Rainald Fischer

20.10.2014