Infection (2018) 46:365–373
Is uoroquinolone monotherapy a useful alternative treatment
for Pseudomonas aeruginosa bacteraemia?
· Yi‑Tsung Lin
· Fu‑Der Wang
· Tsuey‑Ching Yang
· Chang‑Phone Fung
Received: 23 October 2017 / Accepted: 13 March 2018 / Published online: 20 March 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose Pseudomonas aeruginosa bacteraemia is associated with high mortality, and most monotherapies are beta-lactam-
based. We aimed to investigate clinical outcomes of deﬁnitive ﬂuoroquinolone monotherapy versus beta-lactam monotherapy
for P. aeruginosa bacteraemia.
Methods This retrospective study enrolled adult patients receiving deﬁnitive monotherapy with beta-lactam or ﬂuoroqui-
nolone between November 2013 and November 2014 at Taipei Veterans General Hospital. The independent risk factors for
28-day mortality were analyzed by logistic regression and propensity score-adjusted analysis.
Results Among the 105 patients enrolled, 78 patients received beta-lactams and 27 received ﬂuoroquinolones (20 with
ciproﬂoxacin and 7 with levoﬂoxacin). Primary bacteraemia (39.0%) and urinary tract infections (37.1%) were the most
common sources of bacteraemia. The 28-day mortality rate was 11.1% for those receiving ﬂuoroquinolones and 32.1% for
those receiving beta-lactams (P = 0.062). The 28-day mortality rate between the two groups stratiﬁed by APACHE II and
Pitt bacteraemia scores showed no signiﬁcant diﬀerences in each category. Propensity score-adjusted multivariate analysis
revealed that deﬁnitive therapy with a ﬂuoroquinolone was not associated with 28-day mortality (OR 0.42; 95% CI 0.08–2.23;
P = 0.305).
Conclusions Fluoroquinolone might be an alternative to beta-lactam as a deﬁnitive monotherapy for P. aeruginosa bac-
teraemia provided they are active in vitro. Our results could be a basis for further studies and provide a possible target for
antibiotic stewardship interventions in P. aeruginosa bacteraemia.
Keywords Bacteraemia · Beta-lactam · Fluoroquinolone · Monotherapy · Pseudomonas aeruginosa
Pseudomonas aeruginosa is a ubiquitous aerobic Gram-neg-
ative bacterium that causes various infections in humans,
including bloodstream infections, pneumonia, intraabdomi-
nal infections, urinary tract infections and skin and soft tis-
sue infections [1–3]. P. aeruginosa is a leading cause of the
severest infections in patients with immunosuppression or
critical illnesses [3, 4]. P. aeruginosa bacteraemia has a high
mortality rate [1–3, 5–12], and selection of the appropriate
antibiotic(s) to initiate therapy is essential for optimizing the
clinical outcome . Additionally, the emergence of multi-
ple drug-resistant P. aeruginosa strains presents a serious
therapeutic challenge for treatment [13, 14].
The use of a combination of antibiotics as a therapeutic
approach for P. aeruginosa infections has been suggested
previously [15–18]. However, recent studies have suggested
that a combination of more than one antipseudomonal agent
Yi-Tsung Lin and Fu-Der Wang contributed to this manuscript
Electronic supplementary material The online version of this
article (https ://doi.org/10.1007/s1501 0-018-1131-7) contains
supplementary material, which is available to authorized users.
* Yi-Tsung Lin
Division of Infectious Diseases, Department of Medicine,
Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai
Road, Taipei 112, Taiwan
School of Medicine, National Yang-Ming University, Taipei,
Institute of Emergency and Critical Care Medicine, National
Yang-Ming University, Taipei, Taiwan
Department of Biotechnology and Laboratory Science
in Medicine, National Yang-Ming University, Taipei, Taiwan
Division of Infectious Diseases, Sijhih Cathay General
Hospital, New Taipei City, Taiwan