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Infection. 2018 Jun;46(3):365-373. doi: 10.1007/s15010-018-1131-7. Epub 2018 Mar 20.

Is fluoroquinolone monotherapy a useful alternative treatment for Pseudomonas aeruginosa bacteraemia?

Author information

1
Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan.
2
School of Medicine, National Yang-Ming University, Taipei, Taiwan.
3
Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan. ytlin8@vghtpe.gov.tw.
4
Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan. ytlin8@vghtpe.gov.tw.
5
Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan.
6
Division of Infectious Diseases, Sijhih Cathay General Hospital, New Taipei City, Taiwan.

Abstract

PURPOSE:

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.

METHODS:

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.

RESULTS:

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 (Pā€‰=ā€‰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; Pā€‰=ā€‰0.305).

CONCLUSIONS:

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.

KEYWORDS:

Bacteraemia; Beta-lactam; Fluoroquinolone; Monotherapy; Pseudomonas aeruginosa

PMID:
29556979
DOI:
10.1007/s15010-018-1131-7
[Indexed for MEDLINE]

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