Short-Duration vs. Long-Duration of Therapy for Hospital-Acquired or Ventilator-Associated Pneumonia due to Multi-Drug Resistant Pseudomonas aeruginosa

Document Type

Conference Proceeding

Publication Date

1-29-2025

Publication Title

Open Forum Infect Dis

Keywords

avibactam plus ceftazidime, ceftolozane plus tazobactam, lactose, adult, African American, APACHE, bioreactor, cerebrovascular disease, chronic obstructive lung disease, cohort analysis, comorbidity, complication, conference abstract, controlled study, diabetes mellitus, duration, female, home for the aged, hospital acquired pneumonia, human, major clinical study, male, middle aged, mortality, mortality rate, multidrug resistance, multidrug resistant Pseudomonas aeruginosa, nursing home, Pseudomonas aeruginosa, recurrence risk, recurrent disease, retrospective study, treatment duration, ventilator associated pneumonia

Abstract

Background. The duration of therapy for hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP) due to non-lactose fermenter Gram-negatives bacilli including Pseudomonas aeruginosa (PsA) remains a topic of debate. Our study aimed to compare the efficacy of short-duration (≤8 days) to longduration ( >8 days) therapy for HAP/VAP due to multi-drug resistant (MDR) or difficult-to-treat (DTR) PsA infection. Methods. A two-center, retrospective cohort study was conducted from 5/2010 to 12/2022. We included all patients ≥18 years old with HAP or VAP due to MDRor DTR-PsA in respiratory cultures who were treated for ≥72 hours. The primary outcome was a 30-day recurrence from the index culture, and the secondary outcomes were a 60-day recurrence, 30-day, and 60-day mortality from the index culture. Results. Overall, 203 patients (short duration, n=91 and long duration, n=112) were included. Sixty-nine percent were male, and 58.6% were of African American descent. The mean (SD) for age and APACHE II score were 58.5 (15.8) and 23.9 (7.9), respectively. The common comorbidities were diabetes (39.9%), cerebrovascular disease (28.6%), and chronic obstructive pulmonary disease (24.1%). The primary admission source was a nursing home (44.8%). VAP was diagnosed in 53.0% of patients, with DTR-PsA accounting for 58.1% of all infections. Polymicrobial infection was present in 20.1% of the cases with Enterobactarales species present in all cases. Ceftazidime-avibactam and ceftolozane-tazobactam were used for treatment in 33.0% and 47.8%, respectively; combination therapy was used for 11.8% of cases. The 30-day recurrence was significantly lower in the long-duration therapy compared with the short-duration (5.4% vs. 15.9%, p = 0.017). Similarly, there was a lower 60-day recurrence rate in the long-duration group vs. short-duration group (8.9% vs. 24.4%, p=0.026). There were no significant differences in 30-day and 60-day mortality rates observed. Conclusion. Prolonged duration ( >8 days) has resulted in lower recurrence rates of HAP/VAP caused by MDR/DTR PsA infection at 30 and 60 days. Although our study is insightful, a larger-Scale study is necessary, and logistic regression should be conducted to determine the predictors of the significant differences in the primary outcome.

Volume

12

First Page

S301

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