Eradication treatment forPseudomonas aeruginosainfection in adults with bronchiectasis: a systematic review and meta-analysis

Abstract

Introduction:Pseudomonas aeruginosais the most commonly isolated pathogen in bronchiectasis and is associated with worse outcomes. Eradication treatment is recommended by guidelines, but the evidence base is limited. The expected success rate of eradication in clinical practice is not known.Methods:We conducted a systematic review and meta-analysis according to Meta-Analysis of Observational Studies in Epidemiology guidelines. PubMed, Embase, the Cochrane Database of Systematic Reviews andClinicaltrials.govwere searched for studies investigatingP. aeruginosaeradication treatment using antibiotics (systemic or inhaled) in patients with bronchiectasis. The primary outcome was the percentage of patients negative forP. aeruginosaat 12 months after eradication treatment. Cystic fibrosis was excluded.Results:Six observational studies including 289 patients were included in the meta-analysis. Our meta-analysis found a 12-monthP. aeruginosaeradication rate of 40% (95% CI 34–45%; p<0.00001), with no significant heterogeneity (I2=0%). Combined systemic and inhaled antibiotic treatment was associated with a higher eradication rate (48%, 95% CI 41–55%) than systemic antibiotics alone (27%, 13–45%).Conclusion:Eradication treatment in bronchiectasis results in eradication ofP. aeruginosafrom sputum in ∼40% of cases at 12 months. Combined systemic and inhaled antibiotics achieve higher eradication rates than systemic antibiotics alone.

Bronchiectasis management in adults: state of the art and future directions

“…A recent systematic review and meta-analysis of observational studies reported that eradication treatment was associated with a 40% rate of clearing P. aeruginosa at 12 months. Efficacy was greater when systemic antibiotics were combined with an inhaled antibiotic (48% eradication rate) compared with systemic antibiotics alone (27% eradication rate) [ 74 ]. Therefore, current treatment recommendations suggest administration of a susceptibility guided oral fluoroquinolone or intravenous antipseudomonal antibiotics either with or followed by an inhaled antibiotic for 6 weeks to 3 months as an eradication regimen.…”

Exacerbations of bronchiectasis

“…antibiotics are used short-term for management of pulmonary exacerbation and eradication purposes, or long-term as suppressive therapy for maintenance of lung health [ 103 ]. Eradication refers to treatment with the intent to clear the airways of a pathogen and is only recommended for P. aeruginosa infection based on expert consensus, with higher eradication rates achieved by combining systemic and inhaled antibiotics [ 104 ].…”

Moving Beyond Antibiotics: Exploring the Potential of an Antivirulence Monoclonal Antibody against Pseudomonas aeruginosa in Bronchiectasis

“…At present, there are no licensed therapies for bronchiectasis. Although long-term administration of inhaled antibiotics is recommended to treat chronic P. aeruginosa infections according to the guidelines of the European Respiratory Society, a recent meta-analysis of six selected single-center studies representing 2,596 patients indicated overall poor adherence to inhaled antibiotics and limited treatment efficacy in patients with bronchiectasis ( 5 ). The clinical significance of P. aeruginosa infections in the population of patients with bronchiectasis and the lack of an effective treatment against this pathogen clearly highlight the need for new therapies.…”