Monotherapy Efficiency Compared to Combination Therapy for Treatment of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia Targeting Pseudomonas aeruginosa
Location
Suwanee, GA
Start Date
6-5-2025 1:00 PM
End Date
6-5-2025 4:00 PM
Description
Introduction: Pseudomonas aeruginosa is a major cause of serious infections and contributes significantly to morbidity and mortality. This life-threatening pathogen is a common cause of pneumonia, and is resistant to multiple antibiotics. The 2016 Infectious Diseases Society of America recommends combination therapy for the treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) combination caused by P.aeruginosa. Prior antibiotics use within 90 days, and high risk of mortality are risk factors for P.aeruginosa.
Objectives: This review aims to analyze literature that supports the use of combination therapy versus monotherapy for the empiric treatment of P. aeruginosa in HAP and VAP.
Methods: Online databases were used to find articles published pertaining to combination therapy versus monotherapy in the treatment of HAP and/or VAP. Databases used in online literature searches were Google Scholar using keywords Pseudomonas aeruginosa; monotherapy, Sciencedirect using keywords Pseudomonas aeruginosa; combination therapy; monotherapy, PubMed using keywords Pseudomonas aeruginosa; monotherapy;combination; pneumonia. Searches were selected if they met the following inclusion criteria: Study evaluate pseudomonas aeruginosa in pneumonia, HAP, VAP, mortality risk, comparing monotherapy and combination therapy in treatment of P. aeruginosa pneumonia. During the online search, studies were excluded if it pertained to bacteremia, cystic fibrosis, and/or community acquired pneumonia.
Results: Most of the observational studies included in this review found no significant difference in overall mortality between combination therapy and monotherapy, with mortality assessed at 14, 28, 30, and 90 days. Microbiological cure rates were also similar between the two approaches for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Each study also included its own specific antibiotic regimens or interventions. It was noted that initiating appropriate antibiotic therapy is essential to reducing mortality. The monotherapy groups typically had more participants than the combination therapy groups. While the most recent studies are observational in nature, available randomized controlled trials are more than thirty years old. Retrospective and prospective studies remain the primary methods for comparing combination therapy and monotherapy, with randomized trials being infrequently conducted in this context.
Conclusion: Treating P. aeruginosa related pneumonia, whether hospital-acquired, ventilator-associated, or community-acquired, is complex. The evidence of combination therapy compared to monotherapy in treating P. aeruginosa pneumonia is limited. While current guidelines recommend combination therapy, the supporting evidence is weak. Future trials should focus on comparing the efficacy of combination therapy, monotherapy, and newer active agents for treating P.aeruginosa pneumonia.
Embargo Period
5-19-2025
Monotherapy Efficiency Compared to Combination Therapy for Treatment of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia Targeting Pseudomonas aeruginosa
Suwanee, GA
Introduction: Pseudomonas aeruginosa is a major cause of serious infections and contributes significantly to morbidity and mortality. This life-threatening pathogen is a common cause of pneumonia, and is resistant to multiple antibiotics. The 2016 Infectious Diseases Society of America recommends combination therapy for the treatment of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) combination caused by P.aeruginosa. Prior antibiotics use within 90 days, and high risk of mortality are risk factors for P.aeruginosa.
Objectives: This review aims to analyze literature that supports the use of combination therapy versus monotherapy for the empiric treatment of P. aeruginosa in HAP and VAP.
Methods: Online databases were used to find articles published pertaining to combination therapy versus monotherapy in the treatment of HAP and/or VAP. Databases used in online literature searches were Google Scholar using keywords Pseudomonas aeruginosa; monotherapy, Sciencedirect using keywords Pseudomonas aeruginosa; combination therapy; monotherapy, PubMed using keywords Pseudomonas aeruginosa; monotherapy;combination; pneumonia. Searches were selected if they met the following inclusion criteria: Study evaluate pseudomonas aeruginosa in pneumonia, HAP, VAP, mortality risk, comparing monotherapy and combination therapy in treatment of P. aeruginosa pneumonia. During the online search, studies were excluded if it pertained to bacteremia, cystic fibrosis, and/or community acquired pneumonia.
Results: Most of the observational studies included in this review found no significant difference in overall mortality between combination therapy and monotherapy, with mortality assessed at 14, 28, 30, and 90 days. Microbiological cure rates were also similar between the two approaches for hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Each study also included its own specific antibiotic regimens or interventions. It was noted that initiating appropriate antibiotic therapy is essential to reducing mortality. The monotherapy groups typically had more participants than the combination therapy groups. While the most recent studies are observational in nature, available randomized controlled trials are more than thirty years old. Retrospective and prospective studies remain the primary methods for comparing combination therapy and monotherapy, with randomized trials being infrequently conducted in this context.
Conclusion: Treating P. aeruginosa related pneumonia, whether hospital-acquired, ventilator-associated, or community-acquired, is complex. The evidence of combination therapy compared to monotherapy in treating P. aeruginosa pneumonia is limited. While current guidelines recommend combination therapy, the supporting evidence is weak. Future trials should focus on comparing the efficacy of combination therapy, monotherapy, and newer active agents for treating P.aeruginosa pneumonia.