López Montesinos, InmaculadaGómez-Zorrilla, SilviaPalacios-Baena, Zaira RaquelPrim, NúriaEcheverría Esnal, DanielGracia Arnillas, María PilarMontero, Maria MilagroDuran Jordà, Xavier, 1974-Sendra, ElenaSorli Redó, M. LuisaGüerri Fernández, RobertoPadilla, EduardoGrau Cerrato, SantiagoHorcajada Gallego, Juan PabloPROA PSMAR group2022-09-052022-09-052022López 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-z2193-6382http://hdl.handle.net/10230/53990Introduction: 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.application/pdfengCopyright © 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/info:eu-repo/semantics/articlehttp://dx.doi.org/10.1007/s40121-021-00570-zAmikacinAntimicrobial stewardshipColistinExtensively drug-resistant pseudomonas aeruginosaUrinary tract infectionsinfo:eu-repo/semantics/openAccess