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Empiric Anti-Pseudomonal β-Lactam Monotherapy Versus Fluoroquinolone Combination Therapy in Patients With

Moon Seong Baek1, Ae-Rin Baek2, Sang-Bum Hong3

  • 1Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.

Journal of Korean Medical Science
|October 24, 2023
PubMed
Abstract

Insights

Empiric fluoroquinolone combination therapy for hospital-acquired pneumonia (HAP) did not improve survival compared to monotherapy. Routine use of fluoroquinolones in HAP patients at high risk for multidrug-resistant pathogens is not recommended.

Area of Science:

  • Infectious Diseases
  • Clinical Pharmacy
  • Critical Care Medicine

Background:

  • Limited data exists on the efficacy of empiric antibiotic combinations for hospital-acquired pneumonia (HAP).
  • Investigating the impact of empiric anti-pseudomonal fluoroquinolone combination therapy on HAP patient mortality is crucial.

Purpose of the Study:

  • To evaluate whether empiric anti-pseudomonal combination therapy with fluoroquinolones reduces mortality in hospital-acquired pneumonia (HAP) patients.
  • To compare the survival outcomes of HAP patients receiving fluoroquinolone combination therapy versus β-lactam monotherapy.

Main Methods:

  • A multicenter, retrospective cohort study involving 631 adult HAP patients in Korea.
  • Patients were categorized into anti-pseudomonal non-carbapenem β-lactam monotherapy or fluoroquinolone combination therapy groups.
  • Propensity score matching (PSM) was employed to control for confounding variables and assess 30-day mortality.

Main Results:

  • No significant difference in 30-day mortality was observed between monotherapy (16.8%) and combination therapy (18.2%) groups, even after PSM (17.5% vs. 18.2%).
  • The adjusted hazard ratio for 30-day mortality with combination therapy was 1.646 (P=0.189) post-PSM.
  • Appropriateness of initial empiric antibiotics and the prevalence of multidrug-resistant (MDR) pathogens were similar between groups.

Conclusions:

  • Empiric anti-pseudomonal fluoroquinolone combination therapy offers no survival advantage over β-lactam monotherapy for HAP.
  • Clinicians should exercise caution when routinely combining fluoroquinolones for empiric HAP treatment, especially in patients with high risk of MDR infections.
Keywords:
Anti-Bacterial AgentsDrug Resistance, MultipleFluoroquinolonesHealthcare-Associated PneumoniaMortalityPneumonia, Ventilator-Associated

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