Authors (including presenting author) :
Leung BHC(1)(2), Chu JKP(2), Law WL(1), Mak CK(1), Mak LK(1)
Affiliation :
(1)Department of Pharmacy, Tseung Kwan O Hospital, (2)Department of Pharmacology and Pharmacy, The University of Hong Kong
Introduction :
Pseudomonas aeruginosa (PsA) lower respiratory tract infection (LRTI) is characterized by high case-fatality rates and growing resistance. However, clinical data to support either monotherapy or combination therapy remain conflicting. Also, a paucity of PsA LRTI-oriented clinical studies is recognized.
Objectives :
(1) To assess the impact of monotherapy on in-hospital mortality compared with combination therapy in both empirical and definitive PsA LRTI regimens; (2) to evaluate the association of empirical therapy appropriateness, based on in vitro susceptibilities, with in-hospital mortality, readmission and recurrence.
Methodology :
This was a retrospective, observational study using a population-wide database managed by the Hong Kong Hospital Authority. Adult inpatients identified at Tseung Kwan O Hospital from January through December 2017 with monomicrobial PsA LRTI were included in the analysis. Binary logistic regression was used and adjusted for baseline characteristics with statistically significant differences under bivariate analysis.
Result & Outcome :
113 eligible patients were included the analysis. Age and intensive care unit patient type were identified as independent risk factors of PsA LRTI in-hospital mortality. For empirical regimen, the association of mono- or combination therapy with in-hospital mortality and appropriateness remained unknown, as the latter arm involved only three patients (3 vs. 101). Both empirical therapy appropriateness and the use of definitive mono- or combination therapy had no statistically significant influences on in-hospital mortality, readmission and recurrence. Therefore, de-escalation to definitive monotherapy (except aminoglycoside or fluoroquinolone) should be considered on a patient-specific basis.
