Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan.
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Infection. 2018 Jun;46(3):365-373. doi: 10.1007/s15010-018-1131-7. Epub 2018 Mar 20.
Pseudomonas aeruginosa bacteraemia is associated with high mortality, and most monotherapies are beta-lactam-based. We aimed to investigate clinical outcomes of definitive fluoroquinolone monotherapy versus beta-lactam monotherapy for P. aeruginosa bacteraemia.
This retrospective study enrolled adult patients receiving definitive monotherapy with beta-lactam or fluoroquinolone between November 2013 and November 2014 at Taipei Veterans General Hospital. The independent risk factors for 28-day mortality were analyzed by logistic regression and propensity score-adjusted analysis.
Among the 105 patients enrolled, 78 patients received beta-lactams and 27 received fluoroquinolones (20 with ciprofloxacin and 7 with levofloxacin). Primary bacteraemia (39.0%) and urinary tract infections (37.1%) were the most common sources of bacteraemia. The 28-day mortality rate was 11.1% for those receiving fluoroquinolones and 32.1% for those receiving beta-lactams (P = 0.062). The 28-day mortality rate between the two groups stratified by APACHE II and Pitt bacteraemia scores showed no significant differences in each category. Propensity score-adjusted multivariate analysis revealed that definitive therapy with a fluoroquinolone was not associated with 28-day mortality (OR 0.42; 95% CI 0.08-2.23; P = 0.305).
Fluoroquinolone might be an alternative to beta-lactam as a definitive monotherapy for P. aeruginosa bacteraemia provided they are active in vitro. Our results could be a basis for further studies and provide a possible target for antibiotic stewardship interventions in P. aeruginosa bacteraemia.
铜绿假单胞菌菌血症死亡率高，大多数单药治疗均为β-内酰胺类药物。本研究旨在探讨铜绿假单胞菌菌血症的氟喹诺酮类单药治疗与β-内酰胺类单药治疗的临床结局。
本回顾性研究纳入了 2013 年 11 月至 2014 年 11 月期间在台北荣民总医院接受β-内酰胺类或氟喹诺酮类药物确定性单药治疗的成年患者。采用 logistic 回归和倾向评分调整分析方法分析 28 天死亡率的独立危险因素。
在纳入的 105 例患者中，78 例接受了β-内酰胺类药物治疗，27 例接受了氟喹诺酮类药物治疗（环丙沙星 20 例，左氧氟沙星 7 例）。原发性菌血症（39.0%）和尿路感染（37.1%）是菌血症最常见的来源。氟喹诺酮类药物组和β-内酰胺类药物组的 28 天死亡率分别为 11.1%和 32.1%（P=0.062）。根据急性生理与慢性健康状况评分（APACHE II）和 Pitt 菌血症评分对两组进行分层，各亚组的 28 天死亡率无显著差异。倾向评分调整后的多变量分析显示，氟喹诺酮类药物作为铜绿假单胞菌菌血症的确定性治疗与 28 天死亡率无关（OR 0.42；95%CI 0.08-2.23；P=0.305）。
只要体外药敏试验结果显示氟喹诺酮类药物具有活性，氟喹诺酮类药物可能是治疗铜绿假单胞菌菌血症的β-内酰胺类药物的替代药物。本研究结果可为进一步研究提供依据，并为铜绿假单胞菌菌血症的抗生素管理干预提供可能的目标。
