RT Journal Article
T1 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
A1 Lopez-Montesinos, Inmaculada
A1 Gomez-Zorrilla, Silvia
A1 Palacios-Baena, Zaira Raquel
A1 Prim, Nuria
A1 Echeverria-Esnal, Daniel
A1 Gracia, Maria Pilar
A1 Montero, Maria Milagro
A1 Duran-Jorda, Xavier
A1 Sendra, Elena
A1 Sorli, Luisa
A1 Guerri-Fernandez, Roberto
A1 Padilla, Eduardo
A1 Grau, Santiago
A1 Horcajada, Juan Pablo
K1 Extensively drug-resistant Pseudomonas aeruginosa
K1 Urinary tract infections
K1 Amikacin
K1 Colistin
K1 Antimicrobial stewardship
K1 Sepsis
K1 Mortality
AB 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.
PB Springer london ltd
SN 2193-8229
YR 2021
FD 2021-12-03
LK http://hdl.handle.net/10668/21530
UL http://hdl.handle.net/10668/21530
LA en
NO López Montesinos I, Gómez-Zorrilla S, Palacios-Baena ZR, Prim N, Echeverria-Esnal D, Gracia MP, et al.  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):335-350.
DS RISalud
RD Apr 11, 2025