Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel; Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Clin Microbiol Infect. 2023 Jan;29(1):70-76. doi: 10.1016/j.cmi.2022.07.022. Epub 2022 Aug 5.
Ceftriaxone is recommended as first-line antibiotic treatment (with the addition of macrolide) for hospitalised adults with community acquired pneumonia (CAP). Narrower-spectrum β-lactam as ampicillin, may be associated with comparable clinical outcomes, with less emergence of resistant pathogens or Clostridioides difficile infection (CDI). We aimed to examine whether ampicillin and ceftriaxone (with the addition of macrolides for both arms) are comparable for the treatment of hospitalized adults due to CAP.
This was a single center, observational cohort study. We included adult patients who were hospitalized in internal medicine wards due to CAP and were treated with either ceftriaxone or ampicillin with the addition of macrolide. A propensity-score model was used. The primary outcome was 30-day all-cause mortality. A multivariable logistic regression analysis and Kaplan-Meier survival analysis was performed. We performed subgroup analyses for the main outcome based on CURB-65 score and age.
A total of 1586 patients fulfilled the inclusion criteria. There was no difference in 30-day mortality rate in the total cohort (28/233 vs. 208/1353 in ampicillin and ceftriaxone arm, respectively; p = 0.184). In the propensity matched cohort (197 in ampicillin and 394 in ceftriaxone arm), there was no significant difference in 30-day all-cause mortality between treatment groups in multivariable analysis of the main model (OR 0.67, 95% CI, 0.37-1.2; p = 0.189) and Kaplan-Meier survival analysis (p = 0.108). Thirty-day mortality rate was (19/197 vs. 57/394, in ampicillin and ceftriaxone arms, respectively; p = 0.108) Patients who were treated with ampicillin experienced significantly lower rates of CDI (0/197, 0% vs. 8/394, 2%; p = 0.044).
Ampicillin was associated with comparable clinical outcomes in comparison to ceftriaxone for patients who were hospitalized due to CAP. Ampicillin was associated with significantly lower rate of CDI. Results need to be confirmed by more robust study designs.
头孢曲松被推荐作为住院成人社区获得性肺炎（CAP）的一线抗生素治疗药物（联合使用大环内酯类药物）。窄谱β-内酰胺类药物如氨苄西林，可能与类似的临床结局相关，且耐药病原体或艰难梭菌感染（CDI）的发生率更低。我们旨在研究氨苄西林和头孢曲松（联合使用两种药物的大环内酯类药物）治疗住院成人 CAP 是否具有可比性。
这是一项单中心观察性队列研究。我们纳入了因 CAP 而在内科病房住院的成年患者，他们接受了头孢曲松或氨苄西林联合大环内酯类药物治疗。采用倾向评分模型。主要结局为 30 天全因死亡率。进行了多变量逻辑回归分析和 Kaplan-Meier 生存分析。我们根据 CURB-65 评分和年龄对主要结局进行了亚组分析。
共有 1586 名患者符合纳入标准。在总队列中，30 天死亡率无差异（头孢曲松组 28/233 例，氨苄西林组 208/1353 例；p=0.184）。在倾向评分匹配队列（氨苄西林组 197 例，头孢曲松组 394 例）中，多变量主模型分析中两组间 30 天全因死亡率无显著差异（OR 0.67，95%CI，0.37-1.2；p=0.189）和 Kaplan-Meier 生存分析（p=0.108）。30 天死亡率分别为（头孢曲松组 19/233 例，氨苄西林组 57/1353 例；p=0.108）。接受氨苄西林治疗的患者 CDI 发生率明显较低（头孢曲松组 0/197 例，0% vs. 394 例，8%；p=0.044）。
与头孢曲松相比，氨苄西林治疗 CAP 住院患者的临床结局相当。氨苄西林与 CDI 发生率显著降低相关。结果需要更稳健的研究设计来证实。
