Comparison of mono- and combination antibiotic therapy for the treatment of Pseudomonas�aeruginosa bacteraemia: A cumulative meta-analysis of cohort studies

Abstract

It is currently unknown whether antibiotic monotherapy or combination therapy is a more effective treatment for patients with Pseudomonas aeruginosa bacteraemia. The present study consists of a systematic review and meta-analysis of cohort studies in associated studies. The treatment options of monotherapy and combination therapy have been compared, to determine which is more effective against P. aeruginosa bacteraemia. Several electronic bibliographic databases were systematically searched and clinical studies that compared combination therapy with monotherapy for P. aeruginosa bacteraemia were identified. Dersimonian and Laird's random-effects models were used to generate summary estimates of the effects and to assess their association according to different patient characteristics and research quality standards. A total of 17 studies were selected, 3 of which were prospective while the remaining 14 were retrospective. The studies involved a total of 2,504 patients. Significant differences between combination therapy and monotherapy treatment were not found when the data were combined (odds ratio (OR)=0.81, 95% confidence interval (CI)=0.61–1.08; P=0.035). The results demonstrated strength in a number of stratification and sensitivity analyses. The variables used included study type, treatment quality score and survival rate of subgroup analysis. To conduct cumulative meta-analysis, the number of years and samples were calculated. The OR value and 95% CI were stable and demonstrated good change trend. According to the size of the sample order following accumulation, OR values and 95% CI (0.89, 0.76–1.04) exhibited a narrow range. Neither combination therapy or monotherapy exhibited significant effects on the mortality of patients with P. aeruginosa bacteraemia. Future research is required and should include large, well-designed prospective cohorts, and grouped clinical studies.

The Antibacterial and Anti-Biofilm Activity of Metal Complexes Incorporating 3,6,9-Trioxaundecanedioate and 1,10-Phenanthroline Ligands in Clinical Isolates of Pseudomonas aeruginosa from Irish Cystic Fibrosis Patients

“…P. aeruginosa predominantly reside in biofilms in the lungs of CF patients, which are also up to 1000 times more resistant to antibiotic treatment than their planktonic counterparts. Antibiotic treatment strategies are still being trialled and optimized for CF patients, and there have been numerous studies comparing mono- and combination-antibiotic therapies [ 32 , 33 ]. Amongst the many alternative therapeutic approaches documented are the guluronate polymer OligoG (derived from alginate), a simple thiol cysteamine, a novel synthetic peptide, nitric oxide and gallium(III) compounds [ 34 ].…”

A retrospective analysis of Pseudomonas aeruginosa bloodstream infections: prevalence, risk factors, and outcome in carbapenem-susceptible and -non-susceptible infections

“…Previous studies show that inappropriate antimicrobial therapy and/or delayed initiation of effective antimicrobial therapy is associated with an adverse outcome [4, 10]. However, it is unclear whether combination antimicrobial therapy plays a role in mortality associated with PA bloodstream infections (BSIs) [11–14]. Appropriate combination therapy has a favorable effect on survival of patients with febrile neutropenia [15]; however, few studies have focused on antimicrobial therapy.…”

A ten‐year surveillance ofP aeruginosabloodstream infections in a tertiary care hospital: Trends and risk factors for mortality

“…Further, the 30‐day mortality rate was higher in patients who received monotherapy than those who received combination therapy. One meta‐analysis found that combination therapy could decrease mortality rates in patients with P aeruginosa infection; but another meta‐analysis suggested that combination treatment did not influence patient's outcomes, including mortality 32,33 . Noteworthy, this factor was not recognised as an independent predictor of 30‐day mortality in our final model.…”