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Published on: February 23, 2014
Superinfection associated with prolonged antibiotic use in non-ventilator associated hospital-acquired pneumonia
Ying Xian Tan1, Gah Wai Wong2, Ying Huan Tan3
1Department of Pharmacy, Hospital Sultan Haji Ahmad Shah, Ministry of Health, Pahang, Malaysia. yingxian1122@gmail.com.
Abstract:
Background Non-ventilator associated hospital-acquired pneumonia accounts for significant antibiotic use and is associated with a high rate of resistance emergence. However, the optimal duration of antibiotic treatment is uncertain, especially in cases of non-fermenting gram-negative bacilli. Objective To compare a short course (5-7 days) to a prolonged course (10-14 days) of antibiotics for non-ventilator associated hospital-acquired pneumonia. Methods Data collected retrospectively on patients completed treatment in a Malaysian tertiary hospital from January 2017 till December 2018. Regression analysis determined variables independently associated with clinical outcome. Main outcome measures Clinical resolution, superinfection, 30-day and 90-day all-cause mortality between short and prolonged courses. Results Of the 167 patients included, 112 patients were treated with a short course antibiotic, whereas 55 patients received a prolonged course of therapy. Neither short nor prolonged course group has a significantly higher rate of clinical resolution. Short course group had significantly higher mean ± SD antibiotic-free days (21.9 ± 3.5 versus 15.1 ± 6.2 days, p < 0.001). Higher rate of superinfection was observed in prolonged course group compared to short course group (6.3% versus 18.2%, p = 0.027). For non-ventilator associated hospital-acquired pneumonia caused by non-fermenting gram-negative bacilli, the superinfection rate was higher in prolonged course group (35.7% versus 15.4%, p = 0.385) while 30-day mortality rate was higher in the short course group (38.5% versus 14.3%, p = 0.209). Non-fermenting gram-negative bacilli cause higher rate of superinfection (p = 0.010). Conclusion We found no clinical benefit as defined by clinical resolution and reduction in all-cause mortality in prolonging antimicrobial therapy. Superinfections emerge more frequently in prolonged course of antibiotic therapy and more likely to develop in non-fermenting gram-negative bacilli.
Insights
Short antibiotic courses (5-7 days) are as effective as longer ones (10-14 days) for non-ventilator hospital-acquired pneumonia. Prolonged antibiotic therapy increases superinfection risk, especially with non-fermenting gram-negative bacilli.
Area of Science:
- Infectious Diseases
- Hospital-Acquired Infections
- Antimicrobial Stewardship
Background:
- Non-ventilator hospital-acquired pneumonia (NV-HAP) contributes significantly to antibiotic use and antimicrobial resistance.
- Optimal antibiotic treatment duration for NV-HAP, particularly for non-fermenting gram-negative bacilli, remains unclear.
Purpose of the Study:
- To compare the clinical outcomes of short-course (5-7 days) versus prolonged-course (10-14 days) antibiotic therapy for NV-HAP.
- To evaluate the impact of antibiotic duration on clinical resolution, superinfection rates, and mortality.
Main Methods:
- Retrospective data collection from a Malaysian tertiary hospital (January 2017 - December 2018).
- Inclusion of 167 patients who completed antibiotic treatment for NV-HAP.
- Analysis using regression to identify variables associated with clinical outcomes.
Main Results:
- No significant difference in clinical resolution rates between short-course (112 patients) and prolonged-course (55 patients) antibiotic groups.
- Short-course group had significantly more antibiotic-free days (21.9 vs. 15.1 days, p < 0.001).
- Prolonged-course group showed a higher rate of superinfections (18.2% vs. 6.3%, p = 0.027), especially with non-fermenting gram-negative bacilli.
Conclusions:
- Prolonging antimicrobial therapy for NV-HAP beyond 7 days offers no discernible clinical benefit in terms of resolution or mortality reduction.
- Extended antibiotic courses are associated with a higher incidence of superinfections.
- Non-fermenting gram-negative bacilli are linked to increased superinfection rates.
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