Taniguchi Jumpei, Aso Shotaro, Matsui Hiroki, Fushimi Kiyohide, Yasunaga Hideo
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Pharmacoepidemiol Drug Saf. 2025 Jun;34(6):e70162. doi: 10.1002/pds.70162.
Ceftriaxone is believed to increase the risk of biliary infections due to pseudolithiasis caused by ceftriaxone-calcium precipitation, but this risk is not well understood. This study aimed to investigate whether ceftriaxone use is associated with an increased risk of biliary infections in pneumonia patients using a national inpatient database.
We analyzed the Diagnosis Procedure Combination database in Japan, identifying pneumonia patients between July 2010 and March 2022. Patients were grouped by treatment: ceftriaxone versus ampicillin-sulbactam or cefotaxime. Propensity score overlap-weighting was used to adjust for confounding factors. The primary outcome was a composite measure, including cholecystitis or cholangitis during hospitalization, and any percutaneous, endoscopic, or surgical interventions on the biliary tract. Secondary outcomes included individual components of the primary outcome.
Of the 1 503 885 eligible patients, 558 725 received ceftriaxone, while 945 160 were treated with either ampicillin-sulbactam or cefotaxime. The mean dose of ceftriaxone was 1.7 g/day (standard deviation, 0.7 g/day), with a mean administration duration of 7.1 days (standard deviation, 3.8 days). Propensity score overlap-weighting analysis revealed that ceftriaxone treatment was associated with an increased incidence of the composite outcome (0.22% vs. 0.18%; risk difference, 0.05%; 95% confidence interval, 0.03%-0.07%; p < 0.001), as well as the secondary outcomes, including cholecystitis or cholangitis during hospitalization and percutaneous or endoscopic drainage of the gallbladder or biliary tract.
Ceftriaxone use was associated with a slight increase in the risk of biliary infections.
头孢曲松被认为会因头孢曲松 - 钙沉淀导致的假结石而增加胆道感染风险，但这种风险尚未得到充分了解。本研究旨在利用全国住院患者数据库调查肺炎患者使用头孢曲松是否会增加胆道感染风险。
我们分析了日本的诊断程序组合数据库，确定了2010年7月至2022年3月期间的肺炎患者。患者按治疗方式分组：头孢曲松组与氨苄西林 - 舒巴坦组或头孢噻肟组。采用倾向得分重叠加权法调整混杂因素。主要结局是一项综合指标，包括住院期间的胆囊炎或胆管炎，以及对胆道的任何经皮、内镜或手术干预。次要结局包括主要结局的各个组成部分。
在1503885例符合条件的患者中，558725例接受了头孢曲松治疗，而945160例接受了氨苄西林 - 舒巴坦或头孢噻肟治疗。头孢曲松的平均剂量为1.7克/天（标准差，0.7克/天），平均给药持续时间为7.1天（标准差，3.8天）。倾向得分重叠加权分析显示，头孢曲松治疗与综合结局的发生率增加相关（0.22%对0.18%；风险差异，0.05%；95%置信区间，0.03% - 0.07%；p < 0.001），以及与次要结局相关，包括住院期间的胆囊炎或胆管炎以及胆囊或胆道的经皮或内镜引流。
使用头孢曲松与胆道感染风险略有增加相关。
