Aminoglycoside or polymyxin monotherapy for treating complicated urinary tract infections caused by extensively drug-resistant pseudomonas aeruginosa: a propensity score-adjusted and matched cohort study

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  • dc.contributor.author López Montesinos, Inmaculada
  • dc.contributor.author Gómez-Zorrilla, Silvia
  • dc.contributor.author Palacios-Baena, Zaira Raquel
  • dc.contributor.author Prim, Núria
  • dc.contributor.author Echeverría Esnal, Daniel
  • dc.contributor.author Gracia Arnillas, María Pilar
  • dc.contributor.author Montero, Maria Milagro
  • dc.contributor.author Duran Jordà, Xavier, 1974-
  • dc.contributor.author Sendra, Elena
  • dc.contributor.author Sorli Redó, M. Luisa
  • dc.contributor.author Güerri Fernández, Roberto
  • dc.contributor.author Padilla, Eduardo
  • dc.contributor.author Grau Cerrato, Santiago
  • dc.contributor.author Horcajada Gallego, Juan Pablo
  • dc.contributor.author PROA PSMAR group
  • dc.date.accessioned 2022-09-05T06:38:45Z
  • dc.date.available 2022-09-05T06:38:45Z
  • dc.date.issued 2022
  • dc.description.abstract Introduction: 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. Methods: 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. Results: 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%). Conclusions: 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.
  • dc.format.mimetype application/pdf
  • dc.identifier.citation López Montesinos I, Gómez-Zorrilla S, Palacios-Baena ZR, Prim N, Echeverria-Esnal D, Gracia MP, Aminoglycoside or polymyxin monotherapy for treating complicated urinary tract infections caused by extensively drug-resistant pseudomonas aeruginosa: a propensity score-adjusted and matched cohort study. Infect Dis Ther. 2022 Feb; 11(1): 335-50. DOI: 10.1007/s40121-021-00570-z
  • dc.identifier.doi http://dx.doi.org/10.1007/s40121-021-00570-z
  • dc.identifier.issn 2193-6382
  • dc.identifier.uri http://hdl.handle.net/10230/53990
  • dc.language.iso eng
  • dc.publisher SpringerOpen
  • dc.rights Copyright © López Montesinos I, Gómez-Zorrilla S, Palacios-Baena ZR, Prim N, Echeverria-Esnal D, Gracia MP, 2021. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/
  • dc.rights.accessRights info:eu-repo/semantics/openAccess
  • dc.rights.uri http://creativecommons.org/licenses/by-nc/4.0/
  • dc.subject.keyword Amikacin
  • dc.subject.keyword Antimicrobial stewardship
  • dc.subject.keyword Colistin
  • dc.subject.keyword Extensively drug-resistant pseudomonas aeruginosa
  • dc.subject.keyword Urinary tract infections
  • dc.title Aminoglycoside or polymyxin monotherapy for treating complicated urinary tract infections caused by extensively drug-resistant pseudomonas aeruginosa: a propensity score-adjusted and matched cohort study
  • dc.type info:eu-repo/semantics/article
  • dc.type.version info:eu-repo/semantics/publishedVersion

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