Obiageri O Obodozie-Ofoegbu1, Chengwen Teng1, Eric M Mortensen2, Christopher R Frei3. 1. Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX; Pharmacotherapy Education and Research Center, Long School of Medicine, The University of Texas Health San Antonio, San Antonio, TX. 2. Division of Pulmonary and Critical Care Medicine, University of Connecticut School of Medicine, Farmington, CT. 3. Pharmacotherapy Division, College of Pharmacy, The University of Texas at Austin, Austin, TX; Pharmacotherapy Education and Research Center, Long School of Medicine, The University of Texas Health San Antonio, San Antonio, TX; South Texas Veterans Health Care System, San Antonio, TX. Electronic address: freic@uthscsa.edu.
Abstract
BACKGROUND: Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. METHODS: This population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48 hours of hospital admission. RESULTS: The unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and then the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95% CI, 1.50-1.89), medium (aOR, 1.30; 95% CI, 1.14-1.48), and high (aOR, 1.21; 95% CI, 1.04-1.40). CONCLUSIONS: Older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.
BACKGROUND:Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. METHODS: This population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48 hours of hospital admission. RESULTS: The unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and then the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95% CI, 1.50-1.89), medium (aOR, 1.30; 95% CI, 1.14-1.48), and high (aOR, 1.21; 95% CI, 1.04-1.40). CONCLUSIONS: Older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.
Authors: Eric M Mortensen; Brandy Nakashima; John Cornell; Laurel A Copeland; Mary Jo Pugh; Antonio Anzueto; Chester Good; Marcos I Restrepo; John R Downs; Christopher R Frei; Michael J Fine Journal: Clin Infect Dis Date: 2012-08-23 Impact factor: 9.079
Authors: L Leibovici; M Paul; O Poznanski; M Drucker; Z Samra; H Konigsberger; S D Pitlik Journal: Antimicrob Agents Chemother Date: 1997-05 Impact factor: 5.191
Authors: Youn Jeong Kim; Yoon Hee Jun; Yang Ree Kim; Kang Gyun Park; Yeon Joon Park; Ji Young Kang; Sang Il Kim Journal: BMC Infect Dis Date: 2014-03-24 Impact factor: 3.090
Authors: Besu F Teshome; Grace C Lee; Kelly R Reveles; Russell T Attridge; Jim Koeller; Chen-pin Wang; Eric M Mortensen; Christopher R Frei Journal: BMC Infect Dis Date: 2015-09-18 Impact factor: 3.090
Authors: Su Yu Tang; Shun Wen Zhang; Jiang Dong Wu; Fang Wu; Jie Zhang; Jiang Tao Dong; Peng Guo; Da Long Zhang; Jun Ting Yang; Wan Jiang Zhang Journal: Exp Ther Med Date: 2018-01-09 Impact factor: 2.447
Authors: P Riviere; D Patin; E Delaporte; H Mahfoudi; S Lecailtel; F Poher; P Villette; J Duclaux; P Jouault; G Brunin Journal: IDCases Date: 2019-05-16