López Montesinos Inmaculada, Gómez-Zorrilla Silvia, Palacios-Baena Zaira Raquel, Prim Nuria, Echeverria-Esnal Daniel, Gracia María Pilar, Montero María Milagro, Durán-Jordà Xavier, Sendra Elena, Sorli Luisa, Guerri-Fernandez Roberto, Padilla Eduardo, Grau Santiago, Horcajada Juan Pablo
Infectious Diseases Service, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Pompeu Fabra (UPF), Spanish Network for Research in Infectious Diseases (REIPI), Passeig Marítim de La Barceloneta, 25, 29, 08003, Barcelona, Spain.
Unit of Infectious Diseases and Clinical Microbiology. Institute of Biomedicine of Seville (IBIS), University Hospital Virgen Macarena, Av. Dr. Fedriani, 3, 41009, Seville, Spain.
Infect Dis Ther. 2022 Feb;11(1):335-350. doi: 10.1007/s40121-021-00570-z. Epub 2021 Dec 3.
Extensively drug-resistant (XDR) Pseudomonas aeruginosa (PA) infections are difficult to treat. We aimed to compare aminoglycosides or polymyxin monotherapy versus other antibiotic regimens (carbapenems, aztreonam, ceftazidime, cefepime, ceftolozane-tazobactam, or ceftazidime-avibactam) in complicated urinary tract infections (cUTI) caused by XDR-PA.
Study performed at a tertiary-care hospital from 2010 to 2019. All consecutive adult patients with XDR-PA urine cultures and diagnosed with cUTI were retrospectively reviewed. XDR phenotype was defined according to Magiorakos et al. A propensity score was used as a covariate in multivariate analyses and for matching. Primary outcome was early clinical failure and at end of treatment (EOT). Main secondary outcomes were 30- and 90-day mortality, microbiological clearance, and antibiotic-related side effects.
Of the 465 episodes screened, 101 were included, 48% were treated with aminoglycoside or colistin monotherapy. Most XDR-PA were susceptible to colistin (100%) and amikacin (43%). Patients treated with antibiotic regimens other than aminoglycosides or polymyxin monotherapy were more likely to have hematologic malignancy (p < 0.001), higher SOFA score (p = 0.048), and bacteremia (p = 0.003). In multivariate models adjusted by propensity score, aminoglycoside or colistin monotherapy was not associated with worse outcomes. After propensity score matching, 28 episodes in each treatment group were matched. Adjusted ORs (95% CI) for early clinical failure and at EOT with aminoglycosides or polymyxin monotherapy were 0.53 (0.18-1.58) and 1.29 (0.34-4.83), respectively. Aminoglycoside or colistin monotherapy was not associated with higher 30-day (HR 0.93, 95% CI 0.17-5.08) or 90-day mortality (HR 0.68, 95% CI 0.20-2.31), nor with absence of microbiological clearance (OR 0.72, 95% CI 0.33-1.58). No statistically significant differences were found in terms of nephrotoxicity. Clostridioides difficile infection was observed only in the "other antibiotic regimens" group (n = 6, 11.3%).
Aminoglycosides or polymyxin monotherapy showed good efficacy and safety profile in treating cUTI caused by XDR-PA. These results may be useful for antibiotic stewardship activities.
广泛耐药（XDR）铜绿假单胞菌（PA）感染难以治疗。我们旨在比较氨基糖苷类或多粘菌素单药治疗与其他抗生素方案（碳青霉烯类、氨曲南、头孢他啶、头孢吡肟、头孢洛扎-他唑巴坦或头孢他啶-阿维巴坦）在XDR-PA引起的复杂性尿路感染（cUTI）中的疗效。
2010年至2019年在一家三级医疗中心进行研究。对所有连续的成年患者进行回顾性分析，这些患者的尿液培养显示为XDR-PA且被诊断为cUTI。XDR表型根据马焦拉科斯等人的定义确定。倾向评分用作多变量分析中的协变量并用于匹配。主要结局为早期临床失败和治疗结束时（EOT）的情况。主要次要结局为30天和90天死亡率、微生物清除率以及抗生素相关副作用。
在筛查的465例病例中，纳入了101例，48%接受了氨基糖苷类或黏菌素单药治疗。大多数XDR-PA对黏菌素（100%）和阿米卡星（43%）敏感。接受氨基糖苷类或多粘菌素单药治疗以外的抗生素方案治疗的患者更有可能患有血液系统恶性肿瘤（p＜0.001）、较高的序贯器官衰竭评估（SOFA）评分（p = 0.048）和菌血症（p = 0.003）。在根据倾向评分调整的多变量模型中，氨基糖苷类或黏菌素单药治疗与较差结局无关。倾向评分匹配后，每个治疗组匹配了28例病例。氨基糖苷类或多粘菌素单药治疗在早期临床失败和EOT时的调整后比值比（95%置信区间）分别为0.53（0.18 - 1.58）和1.29（0.34 - 4.83）。氨基糖苷类或黏菌素单药治疗与30天（风险比0.93，95%置信区间0.17 -
