Active monotherapy and combination therapy for extensively drug-resistant Pseudomonas aeruginosa pneumonia.

Data on treatment regimens and outcomes of extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) pneumonia are currently limited. A 6-year retrospective cohort study of adult patients diagnosed with XDR-PA pneumonia was conducted between January 2011 and December 2016. All XDR-PA isolates were susceptible to colistin and/or fosfomycin alone. Some XDR-PA isolates, which had minimum inhibitory concentrations for doripenem of 4 or 8 mg/L, were considered to be susceptible to 4-h prolonged infusion therapy with high-dose doripenem. Definite treatment regimens were categorized into three groups: inactive therapy, active monotherapy and active combined two-drug therapy. Outcomes were compared between the three groups. In total, 136 patients were included, and 37% had ventilator-associated pneumonia. Twenty-two, 74 and 40 patients received inactive therapy, active monotherapy and active combined two-drug therapy, respectively. Demographic and clinical characteristics were comparable between the three groups. Rates of 28-day survival and microbiological cure were significantly higher in patients who received active combined two-drug therapy compared with those who received active monotherapy and inactive therapy [90% vs 51% vs 0% (P<0.001) and 90% vs 54% vs 0% (P<0.001), respectively]. Kaplan-Meier survival analysis demonstrated a survival benefit of those who received active combined two-drug therapy over those who received active monotherapy and inactive therapy. Predictors for 28-day mortality were no infectious diseases (ID) consultations [adjusted odds ratio (aOR) 10.93; P<0.001], and receipt of inactive therapy (aOR 42.07; P<0.001) or active monotherapy (aOR 6.63; P=0.002) compared with receipt of active combined two-drug therapy. Active combined two-drug therapy was associated with better survival compared with active monotherapy for XDR-PA pneumonia. ID consultation was associated with a reduction in mortality.

High-throughput label-free image cytometry and image-based classification of live Euglena gracilis.

We demonstrate high-throughput label-free single-cell image cytometry and image-based classification of Euglena gracilis (a microalgal species) under different culture conditions. We perform it with our high-throughput optofluidic image cytometer composed of a time-stretch microscope with 780-nm resolution and 75-Hz line rate, and an inertial-focusing microfluidic device. By analyzing a large number of single-cell images from the image cytometer, we identify differences in morphological and intracellular phenotypes between E. gracilis cell groups and statistically classify them under various culture conditions including nitrogen deficiency for lipid induction. Our method holds promise for real-time evaluation of culture techniques for E. gracilis and possibly other microalgae in a non-invasive manner.

Colistin-based treatment for extensively drug-resistant Acinetobacter baumannii pneumonia.

Data for treatment and outcomes of extensively drug-resistant Acinetobacter baumannii (XDR-AB) pneumonia are limited. A retrospective cohort study of 236 adult patients with XDR-AB pneumonia was conducted between January 2009 and December 2012. The median age of subjects was 70 years (range 17-95 years), 53% were male, 55% had ventilator-associated pneumonia and 42% had been admitted to the intensive care unit. All XDR-AB isolates were susceptible only to tigecycline and colistin; 52 (22%) of the 236 subjects did not receive an agent active against XDR-AB, with an associated 28-day survival of 0%. Colistin-based two-drug combination treatment was prescribed to 166 subjects (70%); regimens included (i) colistin and high-dose sulbactam (n=93); (ii) colistin and tigecycline (n=43); and (iii) colistin and high-dose prolonged infusion of a carbapenem (n=30). The 28-day survival rate and mean length of hospital stay were not statistically different between these three regimens (65%, 53% and 60% and 39, 39 and 38 days, respectively). Predictors of mortality included Acute Physiology and Chronic Health Evaluation (APACHE) II score [adjusted odds ratio (aOR)=1.11; P<0.001 for each point increase], duration from infection onset to receipt of active regimen (aOR=1.01; P=0.002 for each hour delay), underlying malignancy (aOR=3.46; P=0.01) and chronic kidney disease (aOR=2.85; P=0.03). These findings suggest that the three colistin-based two-drug combination regimens may be treatment options for XDR-AB pneumonia.