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

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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 (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).

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.

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Acknowledgements

This work was supported by the Ministry of Science and Technology (MOST 103-2314-B-010-052-MY2) in Taiwan and the Taipei Veterans General Hospital (Grant V105B-001, V106B-001, and V107C-081). We thank the Medical Science and Technology Building of Taipei Veterans General Hospital for providing experimental space and facilities. Some result of this study was presented as an ePoster at the 26th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Amsterdam, Netherlands.

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Author notes

  1. Yi-Tsung Lin and Fu-Der Wang contributed to this manuscript equally.

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, Taipei, 112, Taiwan

    Ping-Feng Wu, Yi-Tsung Lin & Fu-Der Wang

  2. School of Medicine, National Yang-Ming University, Taipei, Taiwan

    Ping-Feng Wu & Fu-Der Wang

  3. Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan

    Yi-Tsung Lin

  4. Department of Biotechnology and Laboratory Science in Medicine, National Yang-Ming University, Taipei, Taiwan

    Tsuey-Ching Yang

  5. Division of Infectious Diseases, Sijhih Cathay General Hospital, New Taipei City, Taiwan

    Chang-Phone Fung

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  1. Ping-Feng Wu
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Correspondence to Yi-Tsung Lin.

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Ethical statement

This study was approved by the Institution Review Board of Taipei Veterans General Hospital, and the written informed consent form was waived.

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The authors declare that they have no conflict of interest.

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Wu, PF., Lin, YT., Wang, FD. et al. Is fluoroquinolone monotherapy a useful alternative treatment for Pseudomonas aeruginosa bacteraemia?. Infection 46, 365–373 (2018). https://doi.org/10.1007/s15010-018-1131-7

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  • DOI: https://doi.org/10.1007/s15010-018-1131-7

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