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Shiroshita A, Tochitani K, Maki Y, Terayama T, Kataoka Y. Association between Empirical Anti-Pseudomonal Antibiotics and Progression to Thoracic Surgery and Death in Empyema: Database Research. Antibiotics (Basel) 2024; 13:383. [PMID: 38786112 PMCID: PMC11117277 DOI: 10.3390/antibiotics13050383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
Evidence on the optimal antibiotic strategy for empyema is lacking. Our database study aimed to evaluate the effectiveness of empirical anti-pseudomonal antibiotics in patients with empyema. We utilised a Japanese real-world data database, focusing on patients aged ≥40 diagnosed with empyema, who underwent thoracostomy and received intravenous antibiotics either upon admission or the following day. Patients administered intravenous vasopressors were excluded. We compared thoracic surgery and death within 90 days after admission between patients treated with empirical anti-pseudomonal and non-anti-pseudomonal antibiotics. Cause-specific hazard ratios for thoracic surgery and death were estimated using Cox proportional hazards models, with adjustment for clinically important confounders. Subgroup analyses entailed the same procedures for patients exhibiting at least one risk factor for multidrug-resistant organisms. Between March 2014 and March 2023, 855 patients with empyema meeting the inclusion criteria were enrolled. Among them, 271 (31.7%) patients received anti-pseudomonal antibiotics. The Cox proportional hazards models indicated that compared to empirical non-anti-pseudomonal antibiotics, empirical anti-pseudomonal antibiotics were associated with higher HRs for thoracic surgery and death within 90 days, respectively. Thus, regardless of the risks of multidrug-resistant organisms, empirical anti-pseudomonal antibiotics did not extend the time to thoracic surgery or death within 90 days.
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Affiliation(s)
- Akihiro Shiroshita
- Division of Epidemiology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN 37203, USA
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Kentaro Tochitani
- Department of Infectious Diseases, Kyoto City Hospital, Kyoto 604-8845, Japan
| | - Yohei Maki
- Division of Infectious Diseases and Respiratory Medicine, National Defense Medical College, Saitama 359-8513, Japan
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Takero Terayama
- Department of Emergency, Self-Defense Forces Central Hospital, Tokyo 154-8532, Japan
| | - Yuki Kataoka
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Kyoto 616-8147, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/Public Health, Kyoto 606-8501, Japan
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Shiroshita A, Yamamoto S, Anan K, Suzuki H, Takeshita M, Kataoka Y. Association Between Empirical Anti-Pseudomonal Antibiotics for Recurrent Lower Respiratory Tract Infections and Mortality: A Retrospective Cohort Study. Int J Chron Obstruct Pulmon Dis 2022; 17:2919-2929. [DOI: 10.2147/copd.s386965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 11/13/2022] [Indexed: 11/18/2022] Open
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Kunadharaju R, Rudraraju A, Sethi S. Pseudomonas aeruginosa Colonization and COPD: The Chicken or the Egg? Arch Bronconeumol 2021; 58:539-541. [DOI: 10.1016/j.arbres.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 11/30/2022]
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