129 - Beta-lactam vs Fluoroquinolone Monotherapy for pseudomonas Aeruginosa infection: A Systematic Review and Meta-analysis

Background: Pseudomonas aeruginosa (PA) is a leading cause of healthcare-associated infections, including pneumonia, bloodstream infections, and surgical site infections around the world. 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. Here, we report a systematic review and meta-analysis 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 Medline and Scopus electronic databases, alongside hand searches of the Cochrane Database of Systematic Reviews, PubMed, and Google Scholar, were performed in April 2019 without 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 (Figure 1).Figure 1.


Results: A total of 368 articles were screened, and 6 studies were included in the meta-analysis. Upon evaluation of methodological quality, 2 studies were rated good, 3 fair, and 1 poor (Table 1). A meta-analysis of 3 cohort studies demonstrates FQ monotherapy for PA bacteremia is associated with increased survival compared to BL monotherapy (OR, 3.65; 95% CI, 1.27-10.44; p=.02; Figure 2). A meta-analysis of 3 randomized control studies demonstrates FQ monotherapy for PA pneumonia and skin and soft tissue infection is not significantly associated with increased bacteriological eradication compared to BL monotherapy (RD, 0.07; 95% CI, -0.09 to 0.24; p=.39; Figure 3).Table 1. Characteristics of selected studies.
Figure 2.
Figure 3.


Conclusion: The data appear to suggest FQ monotherapy is significantly associated with increased survival in PA bacteremia and 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.