Antibiotic treatment adequacy and death among patients with Pseudomonas aeruginosa airway infection


Autoři: Josefin Eklöf aff001;  Kirstine Møller Gliese aff002;  Truls Sylvan Ingebrigtsen aff001;  Uffe Bodtger aff004;  Jens-Ulrik Stæhr Jensen aff001
Působiště autorů: Department of Internal Medicine, Section of Respiratory Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark aff001;  Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark aff002;  Department of Respiratory Medicine, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark aff003;  Department of Respiratory Medicine, Naestved Hospital, University of Southern Denmark, Naestved, Denmark aff004;  Department of Medicine, Zealand University Hospital Roskilde, Roskilde, Denmark aff005;  Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark aff006;  Department of Infectious Diseases, CHIP & PERSIMUNE, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark aff007
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0226935

Souhrn

Objective

The effect of antibiotics on survival in patients with pulmonary Pseudomonas aeruginosa is controversial. The aim of this study is to i) determine the prevalence of adequate antibiotic treatment of P. aeruginosa in an unselected group of adult non-cystic fibrosis patients and ii) to assess the overall mortality in study patients treated with adequate vs. non-adequate antibiotics.

Methods

Prospective, observational study of all adult patients with culture verified P. aeruginosa from 1 January 2010–31 December 2012 in Region Zealand, Denmark. Patients with cystic fibrosis were excluded. Adequate therapy was defined as any antibiotic treatment including at least one antipseudomonal beta-lactam for a duration of at least 10 days. Furthermore, P. aeruginosa had to be tested susceptible to the given antipseudomonal drug and treatment had to be approved by senior clinician to fulfil the adequate-criteria.

Results

A total of 250 patients were identified with pulmonary P. aeruginosa. The vast majority (80%) were treated with non-adequate antibiotic therapy. All-cause mortality rate after 12 months was 49% in adequate treatment group vs. 52% in non-adequate treatment group. Cox regression analysis adjusted for age, gender, bacteraemia, comorbidities and bronchiectasis showed no significant difference in mortality between treatment groups (adequate vs. non-adequate: hazard ratio 0.95, 95% CI 0.59–1.52, P = 0.82).

Conclusion

Adequate antipseudomonal therapy was only provided in a minority of patients with pulmonary P. aeruginosa. Adequate therapy did not independently predict a favourable outcome. New research initiatives are needed to improve the prognosis of this vulnerable group of patients.

Klíčová slova:

Antibiotics – Death rates – Denmark – Drug therapy – Chronic obstructive pulmonary disease – Prognosis – Pseudomonas aeruginosa – Pseudomonas infections


Zdroje

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Článek vyšel v časopise

PLOS One


2019 Číslo 12