Combination Therapy Versus Monotherapy In The Treatment Of Stenotrophomonas Maltophilia Infections: A Systematic Review And Meta-Analysis

Background: Stenotrophomonas maltophilia is a multidrug-resistant bacteria that is difficult to treat in hospitals around the world. It has become a public health issue, as well as being linked to a high mortality rate. Several studies have shown a variety of treatment and clinical outcomes; however, the efficacy of combination therapy remains limited. Therefore, the purpose of this study is to investigate the effect of monotherapy and combination therapy for S. maltophilia infections on mortality outcome.Methods: We performed a systematic review and meta-analysis of combination therapy versus monotherapy in the treatment of S. maltophilia infections on mortality as a clinical outcome. Electronic databases, including Cochrane Library, PubMed, EMBASE, ClinicalTrials.gov, Scopus, and OpenGrey, were systematically searched from the inception of the database until September 3, 2021. Results: Of which 6,524 articles identified, a total of 13 studies and 2 cohort studies were included for systematic review of combination therapy and meta-analysis, respectively. The systematic review of combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection, especially in complex or severe infection. In the fixed-effects meta-analysis of the cohort study, monotherapy was surprisingly shown to have statistically significant effects on the decreased risk of mortality (hazard ratio 1.42; 95% confidence interval, 1.04-1.94). Conclusions: Our results found that the combination antimicrobial therapy had been showed clinically desirable outcome on mortality in S. maltopholia infection and monotherapy has a trend toward improved better outcome than combination therapy on mortality for the treatment of S. maltophilia infections. A longitudinal study that further explores this association is warranted. Trial registration: This study was registered with the trial registration number ID: 210843 under the international prospective register of systematic reviews (PROSPERO: www.crd.york.ac.uk/PROSPERO).

PACK-CXL vs. antimicrobial therapy for bacterial, fungal, and mixed infectious keratitis: a prospective randomized phase 3 trial

Background Infectious keratitis is a major cause of global blindness. We tested whether standalone photoactivated chromophore corneal cross-linking (PACK-CXL) may be an effective first-line treatment in early to moderate infectious keratitis, compared with standard antimicrobial treatment. Methods This is a randomized, controlled, multinational phase 3 clinical trial. Participants in five centers in Egypt, India, Iran, Israel, and China, aged ≥ 18 years, with infectious keratitis of presumed bacterial, fungal, or mixed origin, were randomly assigned (1:1) to PACK-CXL, or antimicrobial therapy. Outcomes measures included healing, defined as time to re-epithelialization of the corneal epithelial defect in the absence of inflammatory activity in the anterior chamber and clearance of stromal infiltrates. Treatment success was defined as the complete resolution of signs of infection. Results Between July 21, 2016, and March 4, 2020, participants were randomly assigned to receive PACK-CXL (n = 18) or antimicrobial therapy per American Academy of Ophthalmology (AAO) guidelines (n = 21). No participants were lost to follow-up. Four eyes were excluded from the epithelialization time analysis due to treatment failure: two in the antimicrobial therapy group, and two in the PACK-CXL group. Success rates were 88.9% (16/18 patients) in the PACK-CXL group and 90.5% (19/21 patients) in the medication group. There was no significant difference in time to complete corneal re-epithelialization (P = 0.828) between both treatment groups. Conclusions PACK-CXL may be an alternative to antimicrobial drugs for first-line and standalone treatment of early to moderate infectious keratitis of bacterial or fungal origin. Trial registration This trial is registered at ClinicalTrials.gov, trial registration number: NCT02717871

Effectiveness of antimicrobial therapy for community-acquired pneumonia in real clinical practice

Background. Community-acquired pneumonia (CAP) remains one of the most common infectious diseases, occupying an important place in the structure of mortality worldwide.Aim. To evaluate the effectiveness of antimicrobial therapy for community-acquired pneumonia in hospitalized patients in real clinical practice.Materials and methods. A retrospective, observational study was conducted, which included 236 patients hospitalized for community-acquired pneumonia at the Regional Clinical Hospital in Ryazan in 2019. Based on these case histories, an analysis of the effectiveness of the initial empiric antimicrobial therapy was performed.Results. The initial empiric antimicrobial therapy in 73% of cases included administration of ceftriaxone, in 45% of cases – levofloxacin, in 14% of cases – azithromycin. It was found that initial antimicrobial therapy was effective in 58% of patients who did not require replacement for the antibiotic. A need for a change in the treatment regimen was significantly associated with an increase in the length of hospitalization (p < 0.001), heart rate upon admission (p = 0.032), myelocyte count in the complete blood count (p < 0.001), and urea and blood creatinine levels (p = 0.004 and p = 0.044, respectively). The selected antimicrobial therapy regimen was significantly associated with the expected treatment effectiveness (p = 0.039). The choice of levofloxacin in monotherapy or in combination with ceftriaxone was accompanied by a decrease in the relative risk of replacing the antimicrobial, compared with other treatment regimens (odds ratio (OR) = 0.86 (95% confidence interval (CI): 0.55–1.34) and OR = 0.57 (95% CI: 0.37–0.87), respectively).Conclusion. Empiric antimicrobial therapy for community-acquired pneumonia in real clinical practice complies with current recommendations, however, at the same time, its ineffectiveness persists. Respiratory fluoroquinolones are most effective in treating pneumonia in hospitalized patients.

Systematic Evaluation of the Accelerate Pheno System for Susceptibility Testing of Gram-Negative Bacteria Isolated from Blood Cultures

Bacteremia is a major cause of morbidity and mortality. Rapid identification of pathogens for early targeted antimicrobial therapy is crucial for detecting emergence of antibiotic resistance and improving outcomes.