Ceftriaxone versus ampicillin/sulbactam for the treatment of aspiration-associated pneumonia in adults
Publication: Journal of Comparative Effectiveness Research
Abstract
Aim: To compare hospital mortality in patients with aspiration-associated pneumonia treated with ceftriaxone (CTRX) and in those treated with ampicillin/sulbactam (ABPC/SBT). Methods: From a Japanese multicentre observational study cohort of patients with pneumonia, those diagnosed with pneumonia and having at least one aspiration-related risk factor were selected. Propensity score-matching analysis was used to balance baseline characteristics of the participants and compare hospital mortality of patients treated with CTRX and those treated with ABPC/SBT. Results: Hospital mortality did not significantly differ between patients treated with CTRX and those treated with ABPC/SBT (6.6 vs 10.7%, risk difference -4.0, 95% CI [-9.4, 1.3]; p = 0.143). Conclusion: Further studies are needed to compare CTRX and ABPC/SBT treatments in patients with aspiration-associated pneumonia.
Supplementary Material
References
Papers of special note have been highlighted as: • of interest
1.
WHO. The top 10 causes of death (2019). https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
2.
Marik PE. Aspiration pneumonitis and aspiration pneumonia. N. Engl. J. Med. 344, 665–671 (2001).
• In order to differentiate between aspiration pneumonitis and aspiration pneumonia, it is important to think about the history.
3.
Reza Shariatzadeh M, Huang JQ, Marrie TJ. Differences in the features of aspiration pneumonia according to site of acquisition: community or continuing care facility. J. Am. Geriatr. Soc. 54, 296–302 (2006).
4.
Lanspa MJ, Jones BE, Brown SM et al. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J. Hosp. Med. 8, 83–90 (2013).
5.
van der M, aarel-Wierink CD, Vanobbergen JNO, Bronkhorst EM et al. Risk factors for aspiration pneumonia in frail older people: a systematic literature review. J. Am. Med. Dir. Assoc. 12, 344–354 (2011).
6.
Bartlett JG, Gorbach SL. Treatment of aspiration pneumonia and primary lung abscess. Penicillin G vs clindamycin. JAMA 234, 935–937 (1975).
• One of the oldest randomized-controlled trials to compare the efficacy of antibiotics for aspiration pneumonia.
7.
Levison ME, Mangura CT, Lorber B et al. Clindamycin compared with penicillin for the treatment of anaerobic lung abscess. Ann. Intern. Med. 98, 466–471 (1983).
8.
Gudiol F, Manresa F, Pallares R et al. Clindamycin vs penicillin for anaerobic lung infections. High rate of penicillin failures associated with penicillin-resistant Bacteroides melaninogenicus. Arch. Intern. Med. 150, 2525–2529 (1990).
9.
Kadowaki M, Demura Y, Mizuno S et al. Reappraisal of clindamycin IV monotherapy for treatment of mild-to-moderate aspiration pneumonia in elderly patients. Chest 127, 1276–1282 (2005).
• Well-qualified study, which shows clindamycin is one of the choices for treatment of aspiration pneumonia.
10.
Allewelt M, Schüler P, Bölcskei PL et al. Ampicillin + sulbactam vs. clindamycin ± cephalosporin for the treatment of aspiration pneumonia and primary lung abscess. Clin. Microbiol. Infect. 10, 163–170 (2004).
11.
Ott SR, Allewelt M, Lorenz J et al. Moxifloxacin vs ampicillin/sulbactam in aspiration pneumonia and primary lung abscess. Infection 36, 23–30 (2008).
12.
Taylor JK, Fleming GB, Singanayagam A et al. Risk factors for aspiration in community-acquired pneumonia: analysis of a hospitalized UK cohort. Am. J. Med. 126, 995–1001 (2013).
13.
Centers for Disease Control and Prevention. Active Bacterial Core Surveillance Report, Emerging Infections Program Network, Streptococcus pneumoniae, 2015 (2019). https://www.cdc.gov/abcs/reports-findings/survreports/spneu15.html
14.
Japan Nosocomial Infections Surveillance, Clinical Laboratory Division. Annual Open Report 2015 (2019). https://janis.mhlw.go.jp/english/report/open_report/2015/4/1/ken_Open_Report_Eng_201500_clsi2012.pdf
15.
Marchese A, Esposito S, Barbieri R et al. Does the adoption of EUCAST susceptibility breakpoints affect the selection of antimicrobials to treat acute community-acquired respiratory tract infections? BMC. Infect. Dis. 12, 181 (2012).
16.
Heffelfinger JD, Dowell SF, Jorgensen JH et al. Management of community-acquired pneumonia in the era of pneumococcal resistance: a report from the drug-resistant Streptococcus pneumoniae Therapeutic Working Group. Arch. Intern. Med. 160, 1399–1408 (2000).
17.
Weinstein MP, Klugman KP, Jones RN. Rationale for revised penicillin susceptibility breakpoints versus Streptococcus pneumoniae: coping with antimicrobial susceptibility in an era of resistance. Clin. Infect. Dis. 48, 1596–1600 (2009).
18.
Ohno A, Ishii Y, Kobayashi I et al. Antibacterial activity and PK/PD of ceftriaxone against penicillin-resistant Streptococcus pneumoniae and β-lactamase-negative ampicillin-resistant Haemophilus influenzae isolates from patients with community-acquired pneumonia. J. Infect. Chemother. 13, 296–301 (2007).
19.
Tristram S, Jacobs MR, Appelbaum PC. Antimicrobial resistance in Haemophilus influenzae. Clin. Microbiol. Rev. 20, 368–389 (2007).
20.
Pichichero ME, Casey JR. Safe use of selected cephalosporins in penicillin-allergic patients: a meta-analysis. Otolaryngol. Head Neck Surg. 136, 340–347 (2007).
21.
Finegold SM. Aspiration pneumonia. Rev. Infect. Dis. 13(Suppl. 9), S737–S742 (1991).
22.
WHO. Antimicrobial resistance (2019). https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance
23.
Morimoto K, Suzuki M, Ishifuji T et al. The burden and etiology of community-onset pneumonia in the aging Japanese population: a multicenter prospective study. PLoS ONE 10, e0122247 (2015).
• Provides information about the patients in the aging society of Japan.
24.
Young P, Hodgson C, Dulhunty J et al. End points for Phase II trials in intensive care: recommendations from the Australian and New Zealand clinical trials group consensus panel meeting. Crit. Care Resusc. 14, 211–215 (2012).
25.
Van Buuren S, Groothuis-Oudshoorn K. Multivariate imputation by chained equations. J. Stat. Softw. 45, 1–67 (2011).
26.
Sekhon J. Multivariate and propensity score matching. J. Stat. Softw. 42, 52 (2011).
27.
RMS: regression Modeling Strategies. R Package Version 4.4.1. (2019). https://CRAN.R-project.org/package=rms
28.
LME4: Linear Mixed-Effects Models using ‘Eigen’ and S4. R Package Version 3.2.0. (2019). https://CRAN.R-project.org/package=lme4
29.
Bartlett JG, Gorbach SL. The triple threat of aspiration pneumonia. Chest 68, 560–566 (1975).
30.
Bartlett JG. Anaerobic bacterial pneumonitis. Am. Rev. Respir. Dis. 119, 19–23 (1979).
31.
Lorber B, Swenson RM. Bacteriology of aspiration pneumonia. A prospective study of community- and hospital-acquired cases. Ann. Intern. Med. 81, 329–331 (1974).
32.
Bartlett JG. Diagnostic accuracy of transtracheal aspiration bacteriologic studies. Am. Rev. Respir. Dis. 115, 777–782 (1977).
33.
Bartlett JG, Gorbach SL, Finegold SM. The bacteriology of aspiration pneumonia. Am. J. Med. 56, 202–207 (1974).
34.
Finegold SM, Bartlett JG, Chow AW et al. Management of anaerobic infections. Ann. Intern. Med. 83, 375–389 (1975).
35.
Marik PE, Carcan P. The role of anaerobes in patients with ventilator-associated pneumonia and aspiration pneumonia: a prospective study. Chest 115, 178–183 (1999).
36.
Takayanagi N, Kagiyama N, Ishiguro T et al. Etiology and outcome of community-acquired lung abscess. Respiration 80, 98–105 (2010).
37.
Bartlett JG. Anaerobic bacterial infection of the lung. Anaerobe 18, 235–239 (2012).
• Highlights the important points regarding anaerobic bacterial infection of the lung.
38.
Dubreuil L, Behra-Miellet J, Vouillot C et al. β-lactamase production in Prevotella and in vitro susceptibilities to selected β-lactam antibiotics. Int. J. Antimicrob. Agents 21, 267–273 (2003).
• This article remarkably shows the antibiotic susceptibility of oral anaerobic pathogens.
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Pages: 1275 - 1284
PubMed: 31736321
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© 2019 Atsushi Shiraishi. This work is licensed under the Attribution-NonCommercial-NoDerivatives 4.0 Unported License
History
Received: 31 March 2019
Accepted: 27 August 2019
Published online: 18 November 2019
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Ceftriaxone versus ampicillin/sulbactam for the treatment of aspiration-associated pneumonia in adults. (2019) Journal of Comparative Effectiveness Research. DOI: 10.2217/cer-2019-0041
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