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

Josefin Eklöf*, Kirstine Møller Gliese, Truls Sylvan Ingebrigtsen, Uffe Bodtger, Jens-Ulrik Stæhr Jensen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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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.

Original languageEnglish
Article numbere0226935
JournalPLOS ONE
Volume14
Issue number12
Pages (from-to)e0226935
Number of pages10
ISSN1932-6203
DOIs
Publication statusPublished - 31. Dec 2019

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Pseudomonas aeruginosa
antibiotics
death
Anti-Bacterial Agents
infection
therapeutics
lungs
Pseudomonas aeruginosa group
beta-Lactams
Regression analysis
Lung
Hazards
beta-lactams
bacteremia
cystic fibrosis
observational studies
fibrosis
Denmark
prognosis
regression analysis

Cite this

Eklöf, Josefin ; Gliese, Kirstine Møller ; Ingebrigtsen, Truls Sylvan ; Bodtger, Uffe ; Jensen, Jens-Ulrik Stæhr. / Antibiotic treatment adequacy and death among patients with Pseudomonas aeruginosa airway infection. In: PLOS ONE. 2019 ; Vol. 14, No. 12. pp. e0226935.
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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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Antibiotic treatment adequacy and death among patients with Pseudomonas aeruginosa airway infection. / Eklöf, Josefin; Gliese, Kirstine Møller; Ingebrigtsen, Truls Sylvan; Bodtger, Uffe; Jensen, Jens-Ulrik Stæhr.

In: PLOS ONE, Vol. 14, No. 12, e0226935, 31.12.2019, p. e0226935.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Antibiotic treatment adequacy and death among patients with Pseudomonas aeruginosa airway infection

AU - Eklöf, Josefin

AU - Gliese, Kirstine Møller

AU - Ingebrigtsen, Truls Sylvan

AU - Bodtger, Uffe

AU - Jensen, Jens-Ulrik Stæhr

PY - 2019/12/31

Y1 - 2019/12/31

N2 - 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.

AB - 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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DO - 10.1371/journal.pone.0226935

M3 - Journal article

C2 - 31891624

VL - 14

SP - e0226935

JO - P L o S One

JF - P L o S One

SN - 1932-6203

IS - 12

M1 - e0226935

ER -