ro13-9904 and Pneumonia--Aspiration

Different antimicrobial treatments have proved to be effective in patients with aspiration pneumonia. However, resistant bacterial strains are commonly observed in hospital settings challenging the empirical treatment of these patients. In this study, we aimed to compare the efficacy of cefepime/clindamycin and ceftriaxone/clindamycin for empiric therapy of poisoned patients with aspiration pneumonia. In an open, randomized, prospective design, 140 consecutive patients aged more than 13 years, with radiographic signs of infiltration in chest radiography and dullness on percussion or pulmonary rales or ronchi in combination with at least two of the following clinical criteria were considered as eligible: fever > or = 37 degrees C (axillary), or hypothermia < 35 degrees C (axillary) and leukocytosis (> 10 cells/mm3), or leukopenia (< 3,000 cells/mm3), a left-shift of > 10%, or purulent sputum or secretion from trachea or bronchi. Participants received intravenously either ceftriaxone 1 g q12 h and clindamycin 900 mg q8 h (group 1) or cefepime 1 g q12 h and clindamycin 900 mg q8 h (group 2). On day 5 of treatment, the number of improved/cured patients was not different between groups (OR 0.86; 95% CI 0.24 to 2.90) nor at 14 days of the study (OR 0.66; 95% CI 0.12 to 3.29). Six patients died in group 1 and 5 in group 2 (RR 0.83; 95% CI 0.28 to 2.46). In conclusion, efficacy of empiric treatment of poisoned patients with aspiration pneumonia with ceftriaxone/clindamycin was comparable to treatment with cefepime/clindamycin.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cefepime; Ceftriaxone; Cephalosporins; Clindamycin; Drug Combinations; Empirical Research; Female; Humans; Male; Middle Aged; Pneumonia, Aspiration; Prospective Studies

Aspiration pneumonia (AP) accounts for 5.0-53.2% of hospitalized pneumonia and the treatment commonly used is by broad-spectrum antibiotics to cover anaerobes. Since ceftriaxone (CTRX) could generally cover oral streptococcus and anaerobes implicated in AP, it could be a useful option in the treatment of AP, instead of piperacillin-tazobactam/(PIPC/TAZ) or Carbapenems.. For the purpose of examining whether CTRX is as effective as broad-spectrum antibiotics for the treatment of AP, this retrospective study included consecutive community-onset patients who were admitted to our institute between 2014 and 2017. These patients were divided into two groups, a CTRX group (n = 25) and a PIPC/TAZ or carbapenems group (n = 97) based on the initial antibiotic treatment. Propensity score matching (PSM) was used to balance the potential confounders, and 23 patients were selected from each group. Patients among CTXR group received CTRX, while those among PIPC/TAZ or carbapenems group received PIPC/TAZ, or carbapenems and/or other agents.. Both groups were well-balanced after PSM. There were no differences in 30-day mortality, duration of hospital stay or antibiotic treatments in the between them. The medical costs were much more expensive in the PIPC/TAZ or carbapenems group than in the CTR group (35,582 v. s. 8678 Japanese yen, p < 0.001).. CTRX is one of the most useful antibiotic treatment for AP, which is not inferior to broad-spectrum antibiotic treatment. In addition, usage of CTRX in the treatment of AP is more economical than broad-spectrum antibiotic treatment, and could contribute to reduction of medical costs.

Topics: Anti-Bacterial Agents; Carbapenems; Ceftriaxone; Humans; Penicillanic Acid; Piperacillin; Piperacillin, Tazobactam Drug Combination; Pneumonia, Aspiration; Propensity Score; Retrospective Studies

Topics: Administration, Oral; Aged; Anti-Bacterial Agents; Cefepime; Ceftriaxone; Cephalosporins; Cross Infection; Drug Therapy, Combination; Drug Utilization; Homes for the Aged; Hospital Mortality; Hospitalization; Humans; Injections, Intramuscular; Nursing Homes; Pneumonia, Aspiration; Pneumonia, Bacterial; Survival Rate; Treatment Failure

To determine the frequency of aspiration pneumonitis in nursing home residents with an initial diagnosis of pneumonia and to compare the clinical characteristics, management, and outcome of aspiration pneumonitis with those of pneumonia.. Retrospective chart review.. Hospital geriatric unit for nursing home residents.. Nursing home residents admitted to the inpatient geriatric unit with suspected pneumonia between May 1999 and April 2001 (n = 195 episodes).. Aspiration events were defined as definite (witnessed or unwitnessed) or suspected. Aspiration pneumonitis was defined as symptoms/signs of lower respiratory tract infection plus a history of an aspiration event plus a lower lobe infiltrate on chest radiograph. Pneumonia was defined as symptoms/signs of lower respiratory tract infection plus an infiltrate on chest radiograph plus no history of an aspiration event.. The 195 episodes were stratified into three clinical groups: aspiration pneumonitis (n = 86; aspiration history/infiltrate), pneumonia (n = 43; no aspiration history/infiltrate), and an aspiration event (n = 66; aspiration history/no infiltrate). In general, symptoms, signs, and laboratory tests were not useful in distinguishing between the three groups. Survivors with aspiration pneumonitis (13/75 (17%)) or with an aspiration event (20/60 (33%)) were significantly more likely not to be treated with an antibiotic or to be treated for 1 day or less than those with pneumonia (0/41; P <.001). Excluding those not treated, significantly more patients with pneumonia (33/40 (83%)) were discharged on antibiotic treatment than those with aspiration pneumonitis (35/70 (50%)) or an aspiration event (21/51 (41%); P <.001). There was no significant difference in hospital mortality between the three clinical groups.. The findings of this study have implications for the diagnosis and management of suspected pneumonia in nursing home residents but require prospective validation.

Topics: Aged; Aged, 80 and over; Algorithms; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Female; Geriatric Assessment; Hospital Mortality; Hospital Units; Humans; Length of Stay; Male; Nursing Homes; Pneumonia; Pneumonia, Aspiration; Retrospective Studies; Severity of Illness Index

The purpose of the present study was to retrospectively review the antibiotic therapy of aspiration or tracheostomy-associated pneumonia in 57 neurologically impaired children (NIC). The antimicrobials used were either ticarcillin-clavulanate or clindamycin, which are effective against penicillin-resistant anaerobic bacteria, or ceftriaxone, which is less effective against these organisms. In those with aspiration pneumonia, a satisfactory clinical and microbiological response was observed in 8/9 (89%) patients who received ticarcillin-clavulanate, and 10/11 (91%) who received clindamycin with or without ceftazidime, as compared to 7/14 (50%) who received ceftriaxone (P < 0.05). For those who experienced tracheostomy-associated pneumonia, a positive response to therapy was observed in 5/6 (83%) who received ticarcillin-clavulanate, and 7/7 (100%) who received clindamycin with or without ceftazidime, as opposed to 4/10 (40%) who were treated with ceftriaxone (P < 0.05). The duration of fever was longer in both cases for those who received ceftriaxone. To summarize, this study illustrates the superiority of antimicrobials effective against penicillin-resistant anaerobic bacteria, as compared to an antibiotic without such coverage, in the therapy of aspiration or tracheostomy-associated pneumonia in NIC.

Topics: Adolescent; Anti-Bacterial Agents; Bacteria, Anaerobic; Bacterial Infections; Ceftazidime; Ceftriaxone; Cephalosporins; Child; Child, Preschool; Clavulanic Acid; Clavulanic Acids; Clindamycin; Female; Fever; Humans; Male; Penicillins; Pneumonia, Aspiration; Pneumonia, Bacterial; Retrospective Studies; Seizures; Ticarcillin; Tracheostomy; Unconsciousness