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KMID : 0191120230380410353
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Journal of Korean Medical Science
2023 Volume.38 No. 41 p.353 ~ p.353
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Empiric Anti-Pseudomonal β-Lactam Monotherapy Versus Fluoroquinolone Combination Therapy in Patients With Hospital-Acquired Pneumonia: A Multicenter Cohort Study With Propensity Score Matching
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Baek Moon-Seong
Baek Ae-Rin
Hong Sang-Bum
Bae Soo-Hyun
Park Hye-Kyeong
Kim Chang-Hwan
Lee Hyun-Kyung
Cho Woo-Hyun
Kim Jin-Hyoung
Chang You-Jin
Lee Heung-Bum
Gil Hyun-Il
Shin Beom-Su
Yoo Kwang-Ha
Moon Jae-Young
Oh Jee-Youn
Min Kyung-Hoon
Jeon Kyeong-Man
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Abstract
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Background : There is insufficient data on the benefits of empiric antibiotic combinations for hospital-acquired pneumonia (HAP). We aimed to investigate whether empiric anti-pseudomonal 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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KEYWORD
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Healthcare-Associated Pneumonia, Pneumonia, Ventilator-Associated, Anti-Bacterial Agents, Fluoroquinolones, Drug Resistance, Multiple, Mortality
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