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Kim Y, Jeon Y, Kwon KT, Bae S, Hwang S, Chang HH, Kim SW, Lee WK, Yang KH, Shin JH, Shim EK. Beta-Lactam Plus Macrolide for Patients Hospitalized With Community-Acquired Pneumonia: Difference Between Autumn and Spring. J Korean Med Sci 2022; 37:e324. [PMID: 36413797 PMCID: PMC9678659 DOI: 10.3346/jkms.2022.37.e324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The 2017 Korean guideline on community-acquired pneumonia (CAP) recommended beta-lactam plus macrolide combination therapy for patients hospitalized with severe pneumonia, and beta-lactam monotherapy for mild-to-moderate pneumonia. However, antibiotic treatment regimen for mild-to-moderate CAP has never been evaluated for Korean patients. METHODS In this retrospective cohort study, study patients were selected from three evaluation periods (October 1 to December 31, 2014; April 1 to June 30, 2016; October 1 to December 31, 2017) of the National Quality Assessment Program for CAP management and the National Health Insurance data on the selected patients was extracted from 1 year before the first patient enrollment and 1 year after the last patient enrollment at each evaluation period for the analysis of risk adjustment and outcomes. The survival rates between beta-lactam plus macrolide (BM) groups and beta-lactam monotherapy (B) were compared using a Kaplan-Meier survival analysis after propensity score matching by age, gender, confusion, urea, respiratory rate, blood pressure at age of 65 years or older (CURB-65), and Charlson comorbidity index for risk adjustment. The differences between autumn and spring season were also evaluated. RESULTS A total of 30,053 patients were enrolled. Mean age and the male-to-female ratio were 64.7 ± 18.4 and 14,197:15,856, respectively. After matching, 2,397 patients in each group were analyzed. The 30-day survival rates did not differ between the BM and B groups (97.3% vs. 96.5%, P = 0.081). In patients with CURB-65 ≥ 2, the 30-day survival rate was higher in the BM than in the B group (93.7% vs. 91.0%, P = 0.044). Among patients with CURB-65 ≥ 2, the 30-day survival rate was higher in the BM than in the B group (93.3% vs. 88.5%, P = 0.009) during autumn season, which was not observed during spring (94.2% vs. 94.1%, P = 0.986). CONCLUSION Beta-lactam plus macrolide combination therapy shows potential as an empirical therapy for CAP with CURB-65 ≥ 2, especially in autumn.
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Affiliation(s)
- Yoonjung Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Yena Jeon
- Department of Statistics, Kyungpook National University, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - Sohyun Bae
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Soyoon Hwang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Shin-Woo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Won Kee Lee
- Department of Medical Informatics, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Ki-Hwa Yang
- Quality Assessment Department, HIRA (Health Insurance Review & Assessment Service), Wonju, Korea
| | - Ji-Hyeon Shin
- Quality Assessment Department, HIRA (Health Insurance Review & Assessment Service), Wonju, Korea
| | - Eun-Kyung Shim
- Quality Assessment Department, HIRA (Health Insurance Review & Assessment Service), Wonju, Korea
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Kaidashev I, Lavrenko A, Baranovskaya T, Blazhko V, Digtiar N, Dziublyk O, Gerasimenko N, Iashyna L, Kryvetskyi V, Kuryk L, Rodionova V, Stets R, Vyshnyvetskyy I, Feshchenko Y. Etiology and efficacy of anti-microbial treatment for community-acquired pneumonia in adults requiring hospital admission in Ukraine. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022238. [PMID: 35545995 PMCID: PMC9171850 DOI: 10.23750/abm.v93i2.13137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIM Empiric therapy of community-acquired pneumonia (CAP) remains the standard care and guidelines are mostly based on published data from the United States or Europe. In this study, we determined the bacterial etiology of CAP and evaluated the clinical outcomes under antimicrobial treatment of CAP in Ukraine. METHODS A total of 98 adult subjects with CAP and PORT risk II-IV were recruited for the study. The sputum diagnostic samples were obtained from all patients for causative pathogen identification. Subjects were randomly assigned in a 1:1 ratio to receive delafloxacin 300 mg (n=51) or moxifloxacin 400 mg (n=47) with blinding placebo. The switch to oral treatment was after a minimum of 6 IV doses according to clinical criteria. The total duration of antibacterial treatment was 5-10 days. In vitro susceptibility of pathogens to delafloxacin and other comparator antibiotics was determined. RESULTS The most frequently isolated pathogens in adults with CAP were S. pneumoniae - 19.5%, M. pneumoniae - 15.3%, H. influenzae - 13.2%, S. aureus - 10.5%, K. pneumoniae - 10.1%, and H. parainfluenzae - 6.4%. All isolates of S. pneumoniae, S. aureus, M. pneumoniae had sufficient susceptibility to appropriate antibiotics. 9.0% of H. influenzae strains were susceptible to azithromycin. 94.8 % of patients had a successful clinical response to delafloxacin at the end of treatment and 93.9 % - at test-of-cure. CONCLUSIONS In Ukraine, the major bacterial agents that induced CAP in adults were S. pneumoniae, M. pneumoniae, H. influenzae, S. aureus, K. pneumoniae, H. parainfluenzae, E. cloacae, L. pneumophila. Delafloxacin is a promising effective antibiotic for monotherapy for CAP in adults and could be used in cases of antimicrobial-resistant strains.
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Affiliation(s)
- Igor Kaidashev
- Department of Internal Medicine n.3 with Phthisiology, Poltava State Medical University, Poltava, Ukraine
| | - Anna Lavrenko
- Department of Internal Medicine n.3 with Phthisiology, Poltava State Medical University, Poltava, Ukraine
| | - Tatiana Baranovskaya
- Kyiv City Clinical Hospital n.17, Department of Clinical Pulmonology, Kyiv (Ukraine)
| | - Victor Blazhko
- Municipal non-profit enterprise “City Clinical Hospital n.13” of Kharkiv City Council, Pulmonology department n.2, Kharkiv (Ukraine)
| | - Nataliia Digtiar
- Department of Internal Medicine n.3 with Phthisiology, Poltava State Medical University, Poltava, Ukraine
| | - Oleksandr Dziublyk
- Department of Pulmonology, State Institution “National Institute of Tuberculosis and Pulmonology. F.G. Yanovsky National Academy of Medical Sciences of Ukraine”, Kyiv (Ukraine)
| | - Nataliia Gerasimenko
- Department of Internal Medicine n.3 with Phthisiology, Poltava State Medical University, Poltava, Ukraine
| | - Liudmyla Iashyna
- Department of Pulmonology, State Institution “National Institute of Tuberculosis and Pulmonology. F.G. Yanovsky National Academy of Medical Sciences of Ukraine”, Kyiv (Ukraine)
| | - Volodymyr Kryvetskyi
- Department of Surgery n.1, National Pirogov Memorial Medical University, Vinnytsia (Ukraine)
| | - Lesya Kuryk
- Department of Pulmonology, State Institution “National Institute of Tuberculosis and Pulmonology. F.G. Yanovsky National Academy of Medical Sciences of Ukraine”, Kyiv (Ukraine)
| | - Victoria Rodionova
- Department of occupational diseases and clinical immunology, Dnipropetrovsk State Medical Academy, Dnipro (Ukraine)
| | - Roman Stets
- Municipal institution “6th city clinical hospital”, Zaporizhzhia (Ukraine)
| | - Ivan Vyshnyvetskyy
- Department of Health Care Management, Bogomolets National Medical University, Kyiv (Ukraine); Department of Clinical Research on the basis of the Department of Emergency Therapy n.1, Municipal Institution Central City Hospital n.1, Zhytomyr (Ukraine)
| | - Yurii Feshchenko
- Department of Pulmonology, State Institution “National Institute of Tuberculosis and Pulmonology. F.G. Yanovsky National Academy of Medical Sciences of Ukraine”, Kyiv (Ukraine)
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