Chloramphenicol versus ceftriaxone for the treatment of pneumonia and sepsis in elderly patients with advanced dementia and functional disability. A propensity-weighted retrospective cohort study.

IF 3.9 2区 医学 Q1 INFECTIOUS DISEASES
Y Eynath, R McNeil, S Buchrits, D Guz, D Fredman, A Gafter-Gvili, T Avni
{"title":"Chloramphenicol versus ceftriaxone for the treatment of pneumonia and sepsis in elderly patients with advanced dementia and functional disability. A propensity-weighted retrospective cohort study.","authors":"Y Eynath, R McNeil, S Buchrits, D Guz, D Fredman, A Gafter-Gvili, T Avni","doi":"10.1093/jac/dkae323","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sepsis and pneumonia in the elderly comprise a significant portion of medical admissions. Chloramphenicol has been used in Israel for treatment of bacterial infections, without evidence regarding its efficacy and safety.</p><p><strong>Objectives: </strong>We aimed to examine whether chloramphenicol was associated with similar outcomes to ceftriaxone, for treatment of sepsis and pneumonia in the elderly with dementia and functional disability.</p><p><strong>Methods: </strong>Patients over 75, with dementia and functional disability, admitted to the internal medicine ward at Beilinson Hospital between 2011 and 2021, with community-acquired aspiration pneumonia or sepsis of undetermined source were included. Patients with mild dementia and independent in their activities of daily living were excluded. Primary outcome was 30- and 90-day all-cause mortality. A propensity-weighted multivariable model was constructed using inverse probability of treatment weighting. Results were expressed as OR with 95% CI.</p><p><strong>Results: </strong>In total, 1558 patients were included: 512 treated with chloramphenicol and 1046 with ceftriaxone. The cohort consisted of elderly patients (mean age 87 ± 6.2 years) with comorbidities; 30- and 90-day all-cause mortality were similar [222/512 (43.3%) versus 439/1046 (41.9%) P = 0.602, and 261/512 (50.9%) versus 556/1046 (53.1%) P = 0.419, respectively]. Propensity-weighted, logistic multivariable analysis for 30- and 90-day all-cause mortality revealed similar mortality rates for chloramphenicol and ceftriaxone (OR 1.049 95% CI 0.217-1.158, OR 0.923 95% CI 0.734-1.112, respectively).</p><p><strong>Conclusion: </strong>In this retrospective cohort of elderly debilitated patients hospitalized with pneumonia and sepsis, we found no difference in 30- and 90-day mortality between those treated with chloramphenicol or ceftriaxone. Further studies should determine the efficacy and safety of chloramphenicol in this population.</p>","PeriodicalId":14969,"journal":{"name":"Journal of Antimicrobial Chemotherapy","volume":" ","pages":"3007-3015"},"PeriodicalIF":3.9000,"publicationDate":"2024-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Antimicrobial Chemotherapy","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/jac/dkae323","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Sepsis and pneumonia in the elderly comprise a significant portion of medical admissions. Chloramphenicol has been used in Israel for treatment of bacterial infections, without evidence regarding its efficacy and safety.

Objectives: We aimed to examine whether chloramphenicol was associated with similar outcomes to ceftriaxone, for treatment of sepsis and pneumonia in the elderly with dementia and functional disability.

Methods: Patients over 75, with dementia and functional disability, admitted to the internal medicine ward at Beilinson Hospital between 2011 and 2021, with community-acquired aspiration pneumonia or sepsis of undetermined source were included. Patients with mild dementia and independent in their activities of daily living were excluded. Primary outcome was 30- and 90-day all-cause mortality. A propensity-weighted multivariable model was constructed using inverse probability of treatment weighting. Results were expressed as OR with 95% CI.

Results: In total, 1558 patients were included: 512 treated with chloramphenicol and 1046 with ceftriaxone. The cohort consisted of elderly patients (mean age 87 ± 6.2 years) with comorbidities; 30- and 90-day all-cause mortality were similar [222/512 (43.3%) versus 439/1046 (41.9%) P = 0.602, and 261/512 (50.9%) versus 556/1046 (53.1%) P = 0.419, respectively]. Propensity-weighted, logistic multivariable analysis for 30- and 90-day all-cause mortality revealed similar mortality rates for chloramphenicol and ceftriaxone (OR 1.049 95% CI 0.217-1.158, OR 0.923 95% CI 0.734-1.112, respectively).

Conclusion: In this retrospective cohort of elderly debilitated patients hospitalized with pneumonia and sepsis, we found no difference in 30- and 90-day mortality between those treated with chloramphenicol or ceftriaxone. Further studies should determine the efficacy and safety of chloramphenicol in this population.

氯霉素与头孢曲松治疗晚期痴呆和功能障碍老年患者的肺炎和败血症。倾向性加权回顾性队列研究。
背景:老年人败血症和肺炎在住院病人中占很大比例。在以色列,氯霉素一直被用于治疗细菌感染,但没有证据表明其有效性和安全性:我们旨在研究氯霉素在治疗患有痴呆症和功能障碍的老年人败血症和肺炎时是否与头孢曲松具有相似的疗效:方法:纳入2011年至2021年间北林森医院内科病房收治的75岁以上患有痴呆症和功能障碍的患者,这些患者均患有社区获得性吸入性肺炎或来源不明的败血症。轻度痴呆且日常生活自理的患者除外。主要结果为30天和90天的全因死亡率。采用治疗反概率加权法构建了倾向加权多变量模型。结果以 OR 和 95% CI 表示:结果:共纳入 1558 例患者:结果:共纳入 1558 例患者:512 例接受氯霉素治疗,1046 例接受头孢曲松治疗。队列中包括有合并症的老年患者(平均年龄为 87 ± 6.2 岁);30 天和 90 天全因死亡率相似[分别为 222/512 (43.3%) 对 439/1046 (41.9%) P = 0.602,261/512 (50.9%) 对 556/1046 (53.1%) P = 0.419]。针对 30 天和 90 天全因死亡率的倾向加权逻辑多变量分析显示,氯霉素和头孢曲松的死亡率相似(OR 1.049 95% CI 0.217-1.158,OR 0.923 95% CI 0.734-1.112):结论:在这组因肺炎和败血症住院的老年衰弱患者的回顾性队列中,我们发现氯霉素和头孢曲松治疗后的 30 天和 90 天死亡率没有差异。进一步的研究应确定氯霉素在这一人群中的疗效和安全性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
9.20
自引率
5.80%
发文量
423
审稿时长
2-4 weeks
期刊介绍: The Journal publishes articles that further knowledge and advance the science and application of antimicrobial chemotherapy with antibiotics and antifungal, antiviral and antiprotozoal agents. The Journal publishes primarily in human medicine, and articles in veterinary medicine likely to have an impact on global health.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术官方微信