piperacillin--tazobactam-drug-combination and Healthcare-Associated-Pneumonia

Both cefoperazone-sulbactam (CFP-SUL) and piperacillin-tazobactam (PIP-TAZ) are β-lactam/β-lactamase inhibitor antibiotics and have a similar antimicrobial spectrum. However, comparative clinical efficacy and safety of CFP-SUL and PIP-TAZ for the treatment of pneumonia remain largely unknown, especially in elderly patients.. Based on a multi-centre registry database, patients aged ≥65 years, diagnosed with severe community-acquired pneumonia (SCAP), hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP), and given empirical therapy with CFP-SUL or PIP-TAZ were included in the analysis. The primary outcome of interest was the proportion of patients achieving clinical cure. Multi-variate logistic regression was conducted to compare odds ratios (OR) for the outcome between patients who received CFP-SUL and patients who received PIP-TAZ.. In total, 941 elderly patients (624 with SCAP, and 317 with either HAP or VAP) were included in this study. Overall in-hospital mortality for the entire cohort was 19%. Clinical cure was achieved in 81% and 83% of patients with SCAP and HAP/VAP, respectively. Multi-variate logistic regression analysis showed similar odds for clinical cure for patients receiving CFP-SUL or PIP-TAZ among those with SCAP [adjusted OR 1.10, 95% confidence interval (CI) 0.71-1.70] or HAP/VAP (adjusted OR 0.72, 95% CI 0.30-1.76). Regarding safety, both CFP-SUL and PIP-TAZ were generally well tolerated with few reported adverse events.. Among elderly patients with SCAP or HAP/VAP, empirical therapy with CFP-SUL is a viable alternative to PIP-TAZ, while considering antibiotic heterogeneity in the antimicrobial stewardship context.

Topics: Age Factors; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefoperazone; Cohort Studies; Community-Acquired Infections; Female; Frail Elderly; Healthcare-Associated Pneumonia; Humans; Male; Piperacillin, Tazobactam Drug Combination; Pneumonia, Ventilator-Associated; Retrospective Studies; Sulbactam; Treatment Outcome

The COVID-19 pandemic has placed significant strain on the oxygen delivery infrastructure of health facilities in resource-constrained health systems. In this case report, we describe a patient with severe COVID-19 pneumonia who was managed with high-flow nasal oxygen for 40 days, with an eventual successful outcome. We discuss the oxygen delivery infrastructure needed to offer this intervention, as well as the psychosocial impact on those undergoing treatment.

Topics: Anti-Bacterial Agents; Anticoagulants; Anxiety; Blood Gas Analysis; Cannula; Citalopram; Counseling; COVID-19; Dexamethasone; Disease Progression; Enoxaparin; Factor Xa Inhibitors; Female; Glucocorticoids; Healthcare-Associated Pneumonia; Hematoma; Humans; Hypoxia; Middle Aged; Oxygen; Oxygen Inhalation Therapy; Patient Care Team; Patient Positioning; Piperacillin, Tazobactam Drug Combination; Prone Position; Psychiatry; Psychosocial Support Systems; Resilience, Psychological; SARS-CoV-2; Selective Serotonin Reuptake Inhibitors; Severity of Illness Index; Social Work Department, Hospital; Thigh; Treatment Outcome