Empiric Anti-Pseudomonal β-Lactam Monotherapy Versus Fluoroquinolone Combination Therapy in Patients With Hospital-Acquired Pneumonia: A Multicenter Cohort Study With Propensity Score Matching

• Published in: Journal of Korean medical science 2023-10, Vol.38 (41), p.e353-e353
• Main Authors: Baek, Moon Seong, Baek, Ae-Rin, Hong, Sang-Bum, Bae, Soohyun, Park, Hye Kyeong, Kim, Changhwan, Lee, Hyun-Kyung, Cho, Woo Hyun, Kim, Jin Hyoung, Chang, Youjin, Lee, Heung Bum, Gil, Hyun-Il, Shin, Beomsu, Yoo, Kwang Ha, Moon, Jae Young, Oh, Jee Youn, Min, Kyung Hoon, Jeon, Kyeongman
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 1011-8934; 1598-6357
• DOI: 10.3346/jkms.2023.38.e353

BACKGROUNDThere is insufficient data on the benefits of empiric antibiotic combinations for hospital-acquired pneumonia (HAP). We aimed to investigate whether empiric anti-pseudomonal combination therapy with fluoroquinolones decreases mortality in patients with HAP.METHODSThis multicenter, retrospective cohort study included adult patients admitted to 16 tertiary and general hospitals in Korea between January 1 and December 31, 2019. Patients with risk factors for combination therapy were divided into anti-pseudomonal non-carbapenem β-lactam monotherapy and fluoroquinolone combination therapy groups. Primary outcome was 30-day mortality. Propensity score matching (PSM) was used to reduce selection bias.RESULTSIn total, 631 patients with HAP were enrolled. Monotherapy was prescribed in 54.7% (n = 345) of the patients, and combination therapy was prescribed in 45.3% (n = 286). There was no significant difference in 30-day mortality between the two groups (16.8% vs. 18.2%, P = 0.729) or even after the PSM (17.5% vs. 18.2%, P = 0.913). After the PSM, adjusted hazard ratio for 30-day mortality from the combination therapy was 1.646 (95% confidence interval, 0.782-3.461; P = 0.189) in the Cox proportional hazards model. Moreover, there was no significant difference in the appropriateness of initial empiric antibiotics between the two groups (55.0% vs. 56.8%, P = 0.898). The proportion of multidrug-resistant (MDR) pathogens was high in both groups.CONCLUSIONEmpiric anti-pseudomonal fluoroquinolone combination therapy showed no survival benefit compared to β-lactam monotherapy in patients with HAP. Caution is needed regarding the routine combination of fluoroquinolones in the empiric treatment of HAP patients with a high risk of MDR.