Beta-Lactam vs. Fluoroquinolone Monotherapy for <i>Pseudomonas aeruginosa</i> Infection: A Systematic Review and Meta-Analysis
Introduction: <i>Pseudomonas aeruginosa</i> (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 al...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/10/12/1483 |
| _version_ | 1797506910790877184 |
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| author | Eric Reid Ryan W. Walters Christopher J. Destache |
| author_facet | Eric Reid Ryan W. Walters Christopher J. Destache |
| author_sort | Eric Reid |
| collection | DOAJ |
| description | Introduction: <i>Pseudomonas aeruginosa</i> (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; <i>p</i> = 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; <i>p</i> = 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. |
| first_indexed | 2024-03-10T04:40:08Z |
| format | Article |
| id | doaj.art-fea02e5dbae942759923a1ae62f100e5 |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-03-10T04:40:08Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-fea02e5dbae942759923a1ae62f100e52023-11-23T03:30:33ZengMDPI AGAntibiotics2079-63822021-12-011012148310.3390/antibiotics10121483Beta-Lactam vs. Fluoroquinolone Monotherapy for <i>Pseudomonas aeruginosa</i> Infection: A Systematic Review and Meta-AnalysisEric Reid0Ryan W. Walters1Christopher J. Destache2School of Medicine, Creighton University, Omaha, NE 68178, USASchool of Medicine, Creighton University, Omaha, NE 68178, USASchool of Medicine, Creighton University, Omaha, NE 68178, USAIntroduction: <i>Pseudomonas aeruginosa</i> (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; <i>p</i> = 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; <i>p</i> = 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.https://www.mdpi.com/2079-6382/10/12/1483fluoroquinolonebeta-lactam<i>Pseudomonas aeruginosa</i> infectionsystematic review |
| spellingShingle | Eric Reid Ryan W. Walters Christopher J. Destache Beta-Lactam vs. Fluoroquinolone Monotherapy for <i>Pseudomonas aeruginosa</i> Infection: A Systematic Review and Meta-Analysis Antibiotics fluoroquinolone beta-lactam <i>Pseudomonas aeruginosa</i> infection systematic review |
| title | Beta-Lactam vs. Fluoroquinolone Monotherapy for <i>Pseudomonas aeruginosa</i> Infection: A Systematic Review and Meta-Analysis |
| title_full | Beta-Lactam vs. Fluoroquinolone Monotherapy for <i>Pseudomonas aeruginosa</i> Infection: A Systematic Review and Meta-Analysis |
| title_fullStr | Beta-Lactam vs. Fluoroquinolone Monotherapy for <i>Pseudomonas aeruginosa</i> Infection: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Beta-Lactam vs. Fluoroquinolone Monotherapy for <i>Pseudomonas aeruginosa</i> Infection: A Systematic Review and Meta-Analysis |
| title_short | Beta-Lactam vs. Fluoroquinolone Monotherapy for <i>Pseudomonas aeruginosa</i> Infection: A Systematic Review and Meta-Analysis |
| title_sort | beta lactam vs fluoroquinolone monotherapy for i pseudomonas aeruginosa i infection a systematic review and meta analysis |
| topic | fluoroquinolone beta-lactam <i>Pseudomonas aeruginosa</i> infection systematic review |
| url | https://www.mdpi.com/2079-6382/10/12/1483 |
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