| アブストラクト | BACKGROUND: Current guidelines for community-acquired pneumonia (CAP) include ampicillin-sulbactam as an initial treatment option, though they do not mandate routine coverage of anaerobic organisms. This study aimed to compare the effectiveness of ampicillin-sulbactam with that of ceftriaxone as initial treatment for CAP in older adults. METHODS: This study was conducted using the target trial emulation framework, using a nationwide Japanese database (May 2010-June 2023). The study included patients aged >/=65 years, admitted to Diagnosis Procedure Combination hospitals for CAP, who received either ampicillin-sulbactam or ceftriaxone as the initial treatment. The exposure group received ampicillin-sulbactam, while the control group received ceftriaxone, both on the day of hospitalization. The primary outcome was in-hospital mortality; the secondary outcome was the development of Clostridioides difficile infection during hospitalization. RESULTS: The study included 26 633 older patients hospitalized with CAP, with 14 906 receiving ampicillin-sulbactam and 11 727 receiving ceftriaxone as initial treatment. After inverse probability of treatment weighting, the ampicillin-sulbactam group was associated with a higher in-hospital mortality rate than the ceftriaxone group (10.5% vs 9.0%, respectively; adjusted risk difference, 1.5% [95% confidence interval, .7%-2.4%]; adjusted odds ratio, 1.19 [1.08-1.31]). The incidence of C difficile infection was numerically higher in the ampicillin-sulbactam group (0.6% vs 0.4%; adjusted risk difference, 0.2% [95% confidence interval, .0%-.4%]; adjusted odds ratio, 1.45 [.99-2.11]). These results were consistent among patients with risk factors for aspiration. CONCLUSIONS: In older patients with CAP, initial treatment with ampicillin-sulbactam was associated with higher mortality compared to treatment with ceftriaxone. |
|---|
| 組織名 | Department of Transformative Infection Control Development Studies, Osaka;University Graduate School of Medicine, Osaka, Japan.;Division of Fostering Required Medical Human Resources, Center for Infectious;Disease Education and Research (CiDER), Osaka University, Osaka, Japan.;Division of Infection Control and Prevention, Osaka University Hospital, Osaka,;Japan.;Division of Epidemiology, Department of Medicine, Vanderbilt University School of;Medicine, Nashville, Tennessee, USA.;Scientific Research Works Peer Support Group (SRWS-PSG), Osaka, Japan.;Department of Internal Medicine, Kyoto Min-iren Asukai Hospital, Kyoto, Japan.;Section of Clinical Epidemiology, Department of Community Medicine, Kyoto;University Graduate School of Medicine, Kyoto, Japan.;Department of Healthcare Epidemiology, Kyoto University Graduate School of;Medicine/School of Public Health, Kyoto, Japan. |
|---|
