Abstract
Introduction: Pseudomonas aeruginosa (PA) is a leading cause of healthcare-associated infections. A variety of antibiotic classes are used in the treatment of PA infections, including beta-lactams (BLs) and fluoroquinolones (FQs), given either together in combination therapy or alone in monotherapy. A systematic review and meta-analysis were performed to evaluate the therapeutic efficacy of BL agents versus FQ agents as active, definitive monotherapy in PA infections in adults. Methods: Comprehensive literature searches of the Medline and Scopus electronic databases, alongside hand searches of the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar, were performed without a time restriction to identify studies published in English comparing BL and FQ agents given as monotherapy for PA infection in hospitalized adults for which mortality, bacteriological eradication, or clinical response was evaluated. One reviewer screened search results based on pre-defined selection criteria. Two reviewers independently assessed included studies for methodological quality using NIH assessment tools. Two fixed-effects meta-analyses were performed. Results: A total of 368 articles were screened, and six studies involving 338 total patients were included in the meta-analysis. Upon evaluation of methodological quality, two studies were rated good, three fair, and one poor. A meta-analysis of three studies demonstrates FQ monotherapy is associated with significantly improved survival compared to BL monotherapy for patients with PA bacteremia (OR, 3.65; 95% CI, 1.27–10.44; p = 0.02). A meta-analysis of three studies demonstrates FQ monotherapy is associated with equivalent bacteriological eradication compared to BL monotherapy for PA pneumonia or skin and soft tissue infection (RD, 0.07; 95% CI, −0.09 to 0.24; p = 0.39). Conclusion: The meta-analyses demonstrate FQ monotherapy significantly improves survival in PA bacteremia and is associated with similar rates of bacteriological eradication in pneumonia and skin and soft tissue infection caused by PA compared to BL monotherapy. However, more research is needed to make meaningful clinical recommendations.
Highlights
Pseudomonas aeruginosa (PA) is a leading cause of healthcare-associated infections
Bacteremia and is associated with similar rates of bacteriological eradication in pneumonia and skin and soft tissue infection caused by PA compared to BL monotherapy
Twenty-four articles were selected for full-text review, review, and six studies were included in the systematic review and meta-analand six studies were included in the systematic review and meta-analysis: three ysis: three cohort [17,18,19] and three randomized control studies [20,21,22]
Summary
Pseudomonas aeruginosa (PA) is a leading cause of healthcare-associated infections. A variety of antibiotic classes are used in the treatment of PA infections, including betalactams (BLs) and fluoroquinolones (FQs), given either together in combination therapy or alone in monotherapy. Pseudomonas aeruginosa (PA) is a pathogenic Gram-negative bacterium and leading cause of healthcare-associated infections (HAIs) around the world [1,2,3]. Some regions within Europe have reported even higher rates, with PA responsible for 10.5% of all HAIs in Spain [3]. PA is known to cause a variety of serious infections, including nosocomial pneumonia, bacteremia, urinary tract infections, and surgical site infections [1,2,3], with nosocomial pneumonia and bacteremia having mortality rates greater than 35% [1].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
