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Observational Study
. 2019 Dec 31;14(12):e0226935.
doi: 10.1371/journal.pone.0226935. eCollection 2019.

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

Josefin Eklöf  1 , Kirstine Møller Gliese  2 , Truls Sylvan Ingebrigtsen  1   3 , Uffe Bodtger  4   5   6 , Jens-Ulrik Stæhr Jensen  1   7
Affiliations
Observational Study

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

Josefin Eklöf et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: TSI reports personal fees from AstraZeneca outside the submitted work. The other authors report no conflicts of interest relevant to this article.

Figures

Fig 1
Fig 1. Unadjusted Kaplan-Meier survival estimates by treatment group in patients with pulmonary Pseudomonas aeruginosa.
Red line: adequate antibiotic treatment. Blue line: non-adequate antibiotic treatment. Log-rank test: p = 0.41.
Fig 2
Fig 2. Adjusted cumulative hazard plot by treatment group in patients with pulmonary Pseudomonas aeruginosa.
Green line: adequate antibiotic treatment. Blue line: non-adequate antibiotic treatment.
Fig 3
Fig 3. Unadjusted Kaplan-Meier survival estimates by treatment group in patients with pulmonary Pseudomonas aeruginosa.
Red line: ≥ 14-days dual antibiotic treatment. Blue line: all other antibiotic treatment regimes. Log-rank test: p = 0.016.
See this image and copyright information in PMC

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