Combination versus monotherapy as definitive treatment for Pseudomonas aeruginosa bacteraemia: a multicentre retrospective observational cohort study

被引：23

作者：

Babich, Tanya ^{[1
]}

Naucler, Pontus ^{[2
,3
]}

Valik, John Karlsson ^{[2
,3
]}

Giske, Christian G. ^{[4
,5
]}

Benito, Natividad ^{[6
,7
]}

Cardona, Ruben ^{[8
]}

Rivera, Alba ^{[9
]}

Pulcini, Celine ^{[10
,11
]}

Fattah, Manal Abdel ^{[11
]}

Haquin, Justine ^{[11
]}

MacGowan, Alasdair ^{[12
]}

Grier, Sally ^{[12
]}

Gibbs, Julie ^{[12
]}

Chazan, Bibiana ^{[13
]}

Yanovskay, Anna ^{[13
]}

Ben Ami, Ronen ^{[1
,14
]}

Landes, Michal ^{[14
]}

Nesher, Lior ^{[15
]}

Zaidman-Shimshovitz, Adi ^{[15
]}

McCarthy, Kate ^{[16
]}

Paterson, David L. ^{[16
]}

Tacconelli, Evelina ^{[17
]}

Buhl, Michael ^{[17
]}

Mauer, Susanna ^{[17
]}

Rodriguez-Bano, Jesus ^{[18
]}

Morales, Isabel ^{[18
]}

Oliver, Antonio ^{[19
]}

Ruiz de Gopegui, Enrique ^{[19
]}

Cano, Angela ^{[20
]}

Machuca, Isabel ^{[20
]}

Gozalo-Marguello, Monica ^{[21
]}

Martinez Martinez, Luis ^{[21
]}

Gonzalez-Barbera, Eva M. ^{[22
]}

Gomez Alfaro, Iris ^{[22
]}

Salavert, Miguel ^{[23
]}

Beovic, Bojana ^{[24
,25
]}

Saje, Andreja ^{[24
,25
]}

Mueller-Premru, Manica ^{[26
]}

Pagani, Leonardo ^{[27
]}

Vitrat, Virginie ^{[28
]}

Kofteridis, Diamantis ^{[29
]}

Zacharioudaki, Maria ^{[29
]}

Maraki, Sofia ^{[29
]}

Weissman, Yulia ^{[1
]}

Paul, Mical ^{[30
]}

Dickstein, Yaakov ^{[30
]}

Leibovici, Leonard ^{[31
]}

Yahav, Dafna ^{[32
]}

机构：

[1] Tel Aviv Univ, Sackler Fac Med, Tel Aviv, Israel

[2] Karolinska Inst, Div Infect Dis, Dept Med Solna, Stockholm, Sweden

[3] Karolinska Univ Hosp, Dept Infect Dis, Stockholm, Sweden

[4] Karolinska Inst, Dept Lab Med, Stockholm, Sweden

[5] Karolinska Univ Hosp, Dept Clin Microbiol, Stockholm, Sweden

[6] Hosp Santa Creu & Sant Pau, Infect Dis Unit, Dept Internal Med, Inst Invest Biomed St Pau, Barcelona, Spain

[7] Univ Autonoma Barcelona, Barcelona, Spain

[8] Hosp Santa Creu & Sant Pau, Dept Internal Med, Barcelona, Spain

[9] Hosp Santa Creu & Sant Pau, Dept Microbiol, Inst Invest Biomed St Pau, Barcelona, Spain

[10] Univ Lorraine, APEMAC, F-54000 Nancy, France

[11] Univ Lorraine, Infect Dis Dept, CHRU Nancy, F-54000 Nancy, France

[12] Southmead Hosp, Dept Infect Sci, Pathol Sci Bldg, Bristol, Avon, England

[13] Technion, Emek Med Ctr, Infect Dis Unit, Rappaport Fac Med, Haifa, Israel

[14] Sourasky Med Ctr, Infect Dis Unit, Tel Aviv, Israel

[15] Ben Gurion Univ Negev, Soroka Med Ctr, Infect Dis Inst, Beer Sheva, Israel

[16] Univ Queensland, UQ Ctr Clin Res, Brisbane, Qld, Australia

[17] Tuebingen Univ Hosp, Div Infect Dis, Tubingen, Germany

[18] Univ Seville, Hosp Univ Virgen Macarena, Microbiol & Med Prevent,Dept Med,Inst Biomed Sevi, Unidad Clin Enfermedades Infecciosas Microbiol &, Seville, Spain

[19] Hosp Univ Son Espases, Inst Invest Illes Balears IdISBa, Serv Microbiol & Unidad Invest, Palma De Mallorca, Spain

[20] Univ Cordoba, Reina Sofia Univ Hosp, Maimonides Biomed Res Inst Cordoba IMIBIC, Infect Dis Unit, Cordoba, Spain

[21] Univ Hosp Marques Valdecilla, Microbiol Serv, IDIVAL, Santander, Spain

[22] La Fe Univ Hosp, Microbiol Dept, Valencia, Spain

[23] Hosp Univ & Politecn La Fe, Infect Dis Unit, Valencia, Spain

[24] Univ Med Ctr, Dept Infect Dis, Ljubljana, Slovenia

[25] Univ Ljubljana, Fac Med, Ljubljana, Slovenia

[26] Univ Ljubljana, Fac Med, Inst Microbiol & Immunol, Ljubljana, Slovenia

[27] Bolzano Cent Hosp, Infect Dis Unit, Bolzano, Italy

[28] Annecy Genevois Hosp Ctr CHANGE, Infect Dis Unit, Annecy, France

[29] Univ Hosp Heraklion, Dept Internal Med, Infect Dis Unit, Iraklion, Greece

[30] Infect Dis Unit, Rambam Hlth Care Campus, Haifa, Israel

[31] Beilinson Med Ctr, Rabin Med Ctr, Med E, Petah Tiqwa, Israel

[32] Beilinson Med Ctr, Rabin Med Ctr, Infect Dis Unit, Petah Tiqwa, Israel

来源：

JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY | 2021年 / 76卷 / 08期

关键词：

BETA-LACTAM MONOTHERAPY; ANTIMICROBIAL THERAPY; ANTIBIOTIC-THERAPY; RISK-FACTORS; MORTALITY; METAANALYSIS; GUIDELINES; AMINOGLYCOSIDE; INFECTIONS; MANAGEMENT;

D O I：

10.1093/jac/dkab134

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background: Pseudomonas aeruginosa bacteraemia is a common and serious infection. No consensus exists regarding whether definitive combination therapy is superior to monotherapy. We aimed to evaluate the impact of combination therapy on mortality. Methods: This was a multicentre retrospective study (nine countries, 25 centres), including 1277 patients with P. aeruginosa bacteraemia during 2009-15. We evaluated the association between beta-lactam plus aminoglycoside or quinolone combination therapy versus beta-lactam monotherapy and mortality. The primary outcome was 30 day all-cause mortality. Univariate and multivariate Cox regression analyses were conducted, introducing combination as a time-dependent variable. Propensity score was conducted to adjust for confounding for choosing combination therapy over monotherapy. Results: Of 1119 patients included, 843 received definitive monotherapy and 276 received combination therapy (59% aminoglycoside and 41% quinolone). Mortality at 30 days was 16.9% (189/1119) and was similar between combination (45/276; 16.3%) and monotherapy (144/843; 17.1%) groups (P=0.765). In multivariate Cox regression, combination therapy was not associated with reduced mortality (HR 0.98, 95% CI 0.64-1.53). No advantage in terms of clinical failure, microbiological failure or recurrent/persistent bacteraemia was demonstrated using combination therapy. Likewise, adverse events and resistance development were similar for the two regimens. Conclusions: In this retrospective cohort, no mortality advantage was demonstrated using combination therapy over monotherapy for P. aeruginosa bacteraemia. Combination therapy did not improve clinical or microbiological failure rates, nor affect adverse events or resistance development. Our finding of no benefit with combination therapy needs confirmation in well-designed randomized controlled trials.

引用

页码：2172 / 2181

页数：10

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