Yamamoto Shungo, Shiroshita Akihiro, Kataoka Yuki, Someko Hidehiro
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.
Open Forum Infect Dis. 2025 Mar 5;12(3):ofaf133. doi: 10.1093/ofid/ofaf133. eCollection 2025 Mar.
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.
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 infection during hospitalization.
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 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.
In older patients with CAP, initial treatment with ampicillin-sulbactam was associated with higher mortality compared to treatment with ceftriaxone.
社区获得性肺炎（CAP）的现行指南将氨苄西林-舒巴坦列为初始治疗选择之一，不过并未强制要求对厌氧菌进行常规覆盖。本研究旨在比较氨苄西林-舒巴坦与头孢曲松作为老年人CAP初始治疗药物的有效性。
本研究采用目标试验模拟框架，利用日本全国性数据库（2010年5月至2023年6月）进行。研究纳入年龄≥65岁、因CAP入住诊断程序组合医院且接受氨苄西林-舒巴坦或头孢曲松作为初始治疗的患者。暴露组在住院当天接受氨苄西林-舒巴坦治疗，而对照组接受头孢曲松治疗。主要结局是住院死亡率；次要结局是住院期间感染的发生情况。
该研究纳入了26633例因CAP住院的老年患者，其中14906例初始治疗接受氨苄西林-舒巴坦，11727例接受头孢曲松。在进行治疗权重的逆概率分析后，氨苄西林-舒巴坦组的住院死亡率高于头孢曲松组（分别为10.5%和9.0%；调整后的风险差异为1.5%[95%置信区间，0.7%-2.4%]；调整后的优势比为1.19[1.08-1.31]）。氨苄西林-舒巴坦组的感染发生率在数值上更高（0.6%对0.4%；调整后的风险差异为0.2%[95%置信区间，0.0%-0.4%]；调整后的优势比为1.45[0.99-2.11]）。这些结果在有误吸危险因素的患者中是一致的。
在老年CAP患者中，与头孢曲松治疗相比，氨苄西林-舒巴坦初始治疗与更高的死亡率相关。
