TY - JOUR
T1 - Antipseudomonal monotherapy or combination therapy for older adults with community-onset pneumonia and multidrug-resistant risk factors
T2 - a retrospective cohort study
AU - Obodozie-Ofoegbu, Obiageri O.
AU - Teng, Chengwen
AU - Mortensen, Eric M.
AU - Frei, Christopher R.
N1 - Funding Information:
Funding/support: The database was built with grant support to E.M.M. from the National Institutes of Health (NIH) and National Institute of Nursing Research (R01 NR010828). C.R.F. was supported in part by a NIH Clinical Research Scholar (KL2) career development award (National Center for Research Resources KL2 RR025766 and National Center for Advancing Translational Sciences KL2 TR000118) and a NIH Clinical and Translational Science Award (UL1 TR002645 and TL1 TR002647) during part of the time this study was conducted. E.M.M. was supported in part by a grant from the Agency for Healthcare Research and Quality (R24 HS022418) and the University of Texas Southwestern Center for Patient-Centered Outcomes Research. This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the NIH. Funding/support: The database was built with grant support to E.M.M. from the National Institutes of Health (NIH) and National Institute of Nursing Research (R01 NR010828). C.R.F. was supported in part by a NIH Clinical Research Scholar (KL2) career development award (National Center for Research Resources KL2 RR025766 and National Center for Advancing Translational Sciences KL2 TR000118) and a NIH Clinical and Translational Science Award (UL1 TR002645 and TL1 TR002647) during part of the time this study was conducted. E.M.M. was supported in part by a grant from the Agency for Healthcare Research and Quality (R24 HS022418) and the University of Texas Southwestern Center for Patient-Centered Outcomes Research. This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the NIH. Conflicts of interest: C.R.F. has received research grants at his institution for investigator-initiated cancer and infectious diseases research from Allergan (formerly Forest) and AstraZeneca in the past 3years.
Funding Information:
Funding/support: The database was built with grant support to E.M.M. from the National Institutes of Health (NIH) and National Institute of Nursing Research (R01 NR010828). C.R.F. was supported in part by a NIH Clinical Research Scholar (KL2) career development award (National Center for Research Resources KL2 RR025766 and National Center for Advancing Translational Sciences KL2 TR000118) and a NIH Clinical and Translational Science Award (UL1 TR002645 and TL1 TR002647) during part of the time this study was conducted. E.M.M. was supported in part by a grant from the Agency for Healthcare Research and Quality (R24 HS022418) and the University of Texas Southwestern Center for Patient-Centered Outcomes Research. This material is the result of work supported with resources and the use of facilities at the South Texas Veterans Health Care System. The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the NIH.
Publisher Copyright:
© 2019 Association for Professionals in Infection Control and Epidemiology, Inc.
PY - 2019/9
Y1 - 2019/9
N2 - Background: Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. Methods: This population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48 hours of hospital admission. Results: The unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and then the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95% CI, 1.50-1.89), medium (aOR, 1.30; 95% CI, 1.14-1.48), and high (aOR, 1.21; 95% CI, 1.04-1.40). Conclusions: Older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.
AB - Background: Infectious Diseases Society of America guidelines recommend empiric antipseudomonal combination therapy when Pseudomonas is suspected. However, combination antipseudomonal therapy is controversial. This study compares all-cause 30-day mortality in older patients who received antipseudomonal monotherapy (PMT) or antipseudomonal combination therapy (PCT) for the treatment of community-onset pneumonia. Methods: This population-based, retrospective cohort study used data from over 150 Veterans Health Administration hospitals. Patients were classified as being at low, medium, or high risk of drug-resistant pathogens. In total, 31,027 patients were assigned to PCT or PMT treatment arms based on antibiotics received in the first 48 hours of hospital admission. Results: The unadjusted 30-day mortality difference between PCT and PMT was most pronounced in the low-risk group (18% vs 8%), followed by the medium-risk group (24% vs 18%) and then the high-risk group (39% vs 33%). PCT was associated with higher 30-day mortality than PMT overall (adjusted odds ratio [aOR], 1.54; 95% confidence interval [CI], 1.43-1.66) in all 3 risk groups: low (aOR, 1.69; 95% CI, 1.50-1.89), medium (aOR, 1.30; 95% CI, 1.14-1.48), and high (aOR, 1.21; 95% CI, 1.04-1.40). Conclusions: Older adults who received combination antipseudomonal therapy for community-onset pneumonia fared worse than those who received monotherapy. Empiric combination antipseudomonal therapy should not be routinely offered to all patients suspected of having pseudomonal pneumonia.
KW - Antibiotics
KW - Mortality
KW - Pseudomonas
KW - Risk score
KW - Survival
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U2 - 10.1016/j.ajic.2019.02.018
DO - 10.1016/j.ajic.2019.02.018
M3 - Article
C2 - 30904374
AN - SCOPUS:85063100124
SN - 0196-6553
VL - 47
SP - 1053
EP - 1058
JO - American Journal of Infection Control
JF - American Journal of Infection Control
IS - 9
ER -