- Original Research
- Open Access
- Published: 03 December 2021
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
- Inmaculada López Montesinos ORCID: orcid.org/0000-0002-5987-068X1,
- Silvia Gómez-Zorrilla1,
- Zaira Raquel Palacios-Baena2,
- Nuria Prim3,
- Daniel Echeverria-Esnal4,
- María Pilar Gracia5,
- María Milagro Montero1,
- Xavier Durán-Jordà6,
- Elena Sendra1,
- Luisa Sorli1,
- Roberto Guerri-Fernandez1,
- Eduardo Padilla3,
- Santiago Grau4,
- Juan Pablo Horcajada1 on behalf of
- PROA PSMAR group
Infectious Diseases and Therapy [2021]Cite this article
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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