Effectiveness of Ampicillin-Sulbactam Versus Ceftriaxone for the Initial Treatment of Community-Acquired Pneumonia in Older Adults: A Target Trial Emulation Study.
{"title":"Effectiveness of Ampicillin-Sulbactam Versus Ceftriaxone for the Initial Treatment of Community-Acquired Pneumonia in Older Adults: A Target Trial Emulation Study.","authors":"Shungo Yamamoto, Akihiro Shiroshita, Yuki Kataoka, Hidehiro Someko","doi":"10.1093/ofid/ofaf133","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Current guidelines for community-acquired pneumonia (CAP) include ampicillin-sulbactam as an initial treatment option, though they do not mandate routine coverage of anaerobic organisms. This study aimed to compare the effectiveness of ampicillin-sulbactam with that of ceftriaxone as initial treatment for CAP in older adults.</p><p><strong>Methods: </strong>This study was conducted using the target trial emulation framework, using a nationwide Japanese database (May 2010-June 2023). The study included patients aged ≥65 years, admitted to Diagnosis Procedure Combination hospitals for CAP, who received either ampicillin-sulbactam or ceftriaxone as the initial treatment. The exposure group received ampicillin-sulbactam, while the control group received ceftriaxone, both on the day of hospitalization. The primary outcome was in-hospital mortality; the secondary outcome was the development of <i>Clostridioides difficile</i> infection during hospitalization.</p><p><strong>Results: </strong>The study included 26 633 older patients hospitalized with CAP, with 14 906 receiving ampicillin-sulbactam and 11 727 receiving ceftriaxone as initial treatment. After inverse probability of treatment weighting, the ampicillin-sulbactam group was associated with a higher in-hospital mortality rate than the ceftriaxone group (10.5% vs 9.0%, respectively; adjusted risk difference, 1.5% [95% confidence interval, .7%-2.4%]; adjusted odds ratio, 1.19 [1.08-1.31]). The incidence of <i>C difficile</i> infection was numerically higher in the ampicillin-sulbactam group (0.6% vs 0.4%; adjusted risk difference, 0.2% [95% confidence interval, .0%-.4%]; adjusted odds ratio, 1.45 [.99-2.11]). These results were consistent among patients with risk factors for aspiration.</p><p><strong>Conclusions: </strong>In older patients with CAP, initial treatment with ampicillin-sulbactam was associated with higher mortality compared to treatment with ceftriaxone.</p>","PeriodicalId":19517,"journal":{"name":"Open Forum Infectious Diseases","volume":"12 3","pages":"ofaf133"},"PeriodicalIF":3.8000,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11934920/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Open Forum Infectious Diseases","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ofid/ofaf133","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"IMMUNOLOGY","Score":null,"Total":0}
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Abstract
Background: Current guidelines for community-acquired pneumonia (CAP) include ampicillin-sulbactam as an initial treatment option, though they do not mandate routine coverage of anaerobic organisms. This study aimed to compare the effectiveness of ampicillin-sulbactam with that of ceftriaxone as initial treatment for CAP in older adults.
Methods: This study was conducted using the target trial emulation framework, using a nationwide Japanese database (May 2010-June 2023). The study included patients aged ≥65 years, admitted to Diagnosis Procedure Combination hospitals for CAP, who received either ampicillin-sulbactam or ceftriaxone as the initial treatment. The exposure group received ampicillin-sulbactam, while the control group received ceftriaxone, both on the day of hospitalization. The primary outcome was in-hospital mortality; the secondary outcome was the development of Clostridioides difficile infection during hospitalization.
Results: The study included 26 633 older patients hospitalized with CAP, with 14 906 receiving ampicillin-sulbactam and 11 727 receiving ceftriaxone as initial treatment. After inverse probability of treatment weighting, the ampicillin-sulbactam group was associated with a higher in-hospital mortality rate than the ceftriaxone group (10.5% vs 9.0%, respectively; adjusted risk difference, 1.5% [95% confidence interval, .7%-2.4%]; adjusted odds ratio, 1.19 [1.08-1.31]). The incidence of C difficile infection was numerically higher in the ampicillin-sulbactam group (0.6% vs 0.4%; adjusted risk difference, 0.2% [95% confidence interval, .0%-.4%]; adjusted odds ratio, 1.45 [.99-2.11]). These results were consistent among patients with risk factors for aspiration.
Conclusions: In older patients with CAP, initial treatment with ampicillin-sulbactam was associated with higher mortality compared to treatment with ceftriaxone.
期刊介绍：
Open Forum Infectious Diseases provides a global forum for the publication of clinical, translational, and basic research findings in a fully open access, online journal environment. The journal reflects the broad diversity of the field of infectious diseases, and focuses on the intersection of biomedical science and clinical practice, with a particular emphasis on knowledge that holds the potential to improve patient care in populations around the world. Fully peer-reviewed, OFID supports the international community of infectious diseases experts by providing a venue for articles that further the understanding of all aspects of infectious diseases.
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