Empiric Anti-Pseudomonal β-Lactam Monotherapy Versus Fluoroquinolone Combination Therapy in Patients With Hospital-Acquired Pneumonia: A Multicenter Cohort Study With Propensity Score Matchingopen accessEmpiric Anti-Pseudomonal β-Lactam Monotherapy Versus Fluoroquinolone Combination Therapy in Patients With Hospital-Acquired Pneumonia: A Multicenter Cohort Study With Propensity Score Matching
- Authors
- Baek Moon Seong; Baek Ae-Rin; Hong Sang-Bum; Bae Soohyun; Park Hye Kyeong; Kim Changhwan; Lee Hyun-Kyung; Cho Woo Hyun; Kim Jin Hyoung; Chang Youjin; Lee Heung Bum; Gil Hyun-Il; Shin Beomsu; Yoo Kwang Ha; Moon Jae Young; Oh Jee Youn; Min Kyung Hoon; Jeon Kyeongman
- Issue Date
- Oct-2023
- Publisher
- 대한의학회
- Keywords
- Healthcare-Associated Pneumonia; Pneumonia; Ventilator-Associated; Anti-Bacterial Agents; Fluoroquinolones; Drug Resistance; Multiple; Mortality
- Citation
- Journal of Korean Medical Science, v.38, no.41, pp 1 - 13
- Pages
- 13
- Journal Title
- Journal of Korean Medical Science
- Volume
- 38
- Number
- 41
- Start Page
- 1
- End Page
- 13
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/70338
- DOI
- 10.3346/jkms.2023.38.e353
- ISSN
- 1011-8934
1598-6357
- Abstract
- Background: There is insufficient data on the benefits of empiric antibiotic combinations for hospital-acquired pneumonia (HAP). We aimed to investigate whether empiric antipseudomonal combination therapy with fluoroquinolones decreases mortality in patients with HAP.
Methods: This multicenter, retrospective cohort study included adult patients admitted to 16 tertiary and general hospitals in Korea between January 1 and December 31, 2019.
Patients with risk factors for combination therapy were divided into anti-pseudomonal non-carbapenem β-lactam monotherapy and fluoroquinolone combination therapy groups.
Primary outcome was 30-day mortality. Propensity score matching (PSM) was used to reduce selection bias.
Results: In total, 631 patients with HAP were enrolled. Monotherapy was prescribed in 54.7% (n = 345) of the patients, and combination therapy was prescribed in 45.3% (n = 286).
There was no significant difference in 30-day mortality between the two groups (16.8% vs.
18.2%, P = 0.729) or even after the PSM (17.5% vs. 18.2%, P = 0.913). After the PSM, adjusted hazard ratio for 30-day mortality from the combination therapy was 1.646 (95% confidence interval, 0.782–3.461; P = 0.189) in the Cox proportional hazards model. Moreover, there was no significant difference in the appropriateness of initial empiric antibiotics between the two groups (55.0% vs. 56.8%, P = 0.898). The proportion of multidrug-resistant (MDR) pathogens was high in both groups.
Conclusion: Empiric anti-pseudomonal fluoroquinolone combination therapy showed no survival benefit compared to β-lactam monotherapy in patients with HAP. Caution is needed regarding the routine combination of fluoroquinolones in the empiric treatment of HAP patients with a high risk of MDR.
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