Exclusive oral antibiotic treatment for hospitalized community-acquired pneumonia: a post-hoc analysis of a randomized clinical trial.

Autor:	Dinh A; Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France; Epidemiology and Modeling of Bacterial Evasion to Antibacterials Unit (EMEA), Institut Pasteur, Paris, France. Electronic address: aurelien.dinh@aphp.fr., Duran C; Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France., Ropers J; Clinical Research Unit, Pitié-Salpétrière University Hospital, AP-HP, Paris, France., Bouchand F; Department of Pharmacy, Raymond-Poincaré University Hospital, AP-HP Paris Saclay, Garches, France., Deconinck L; Department of Infectious Disease, Bichat University Hospital, AP-HP, University of Paris, Paris, France., Matt M; Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France., Senard O; Department of Infectious Disease, Marne La Vallée Hospital, GHEF, Marne La Vallée, France., Lagrange A; Department of Pneumology, Pontoise Hospital, Pontoise, France., Mellon G; Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France., Calin R; Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France., Makhloufi S; Infectious Diseases Unit, Raymond-Poincaré University Hospital, AP-HP Paris Saclay University, Garches, France., de Lastours V; Internal Medicine, Beaujon University Hospital, AP-HP, Clichy, France., Mathieu E; Emergency Medicine, Foch Hospital, Suresnes, France., Kahn JE; Internal Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France., Rouveix E; Internal Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France., Grenet J; Emergency Medicine, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France., Dumoulin J; Department of Pneumology, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France., Chinet T; Department of Pneumology, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France., Pépin M; Department of Geriatric, Ambroise-Paré University Hospital, AP-HP Paris Saclay, Boulogne-Billancourt, France., Delcey V; Internal Medicine, Lariboisière University Hospital, AP-HP, Paris, France., Diamantis S; Department of Infectious Disease, Melun Hospital, Melun, France., Benhamou D; Department of Pneumology, Rouen University Hospital, Rouen, France., Vitrat V; Infectious Disease, Annecy Hospital, Annecy, France., Dombret MC; Department of Pneumology, Bichat University Hospital, AP-HP, Paris, France., Renaud B; Department of Emergency, Cochin University Hospital, AP-HP, Paris, France., Claessens YE; Emergency Department, Princesse Grace University Hospital, Monaco, France., Labarère J; Quality of Care Unit, Grenoble University Hospital, Grenoble Alpes University, Grenoble, France., Bedos JP; Intensive Care Unit, Le Chesnay Hospital, Versailles, France., Aegerter P; UMRS 1168 VIMA, INSERM, Versailles Saint-Quentin University, Versailles, France., Crémieux AC; Infectious Diseases Unit, Saint-Louis University Hospital, AP-HP, Paris, France.
Jazyk:	angličtina
Zdroj:	Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases [Clin Microbiol Infect] 2024 Aug; Vol. 30 (8), pp. 1020-1028. Date of Electronic Publication: 2024 May 09.
DOI:	10.1016/j.cmi.2024.05.003
Abstrakt:	Objectives: In this study, we aimed to assess the efficacy of different ways of administration and types of beta-lactams for hospitalized community-acquired pneumonia (CAP). Methods: In this post-hoc analysis of randomized controlled trials (RCT) on patients hospitalized for CAP (pneumonia short treatment trial) comparing 3-day vs. 8-day durations of beta-lactams, which concluded to non-inferiority, we included patients who received either amoxicillin-clavulanate (AMC) or third-generation cephalosporin (3GC) regimens, and exclusively either intravenous or oral treatment for the first 3 days (followed by either 5 days of oral placebo or AMC according to randomization). The choice of route and molecule was left to the physician in charge. The main outcome was a failure at 15 days after the first antibiotic intake, defined as temperature >37.9°C, and/or absence of resolution/improvement of respiratory symptoms, and/or additional antibiotic treatment for any cause. The primary outcome according to the route of administration was evaluated through logistic regression. Inverse probability treatment weighting with a propensity score model was used to adjust for non-randomization of treatment routes and potential confounders. The difference in failure rates was also evaluated among several sub-populations (AMC vs. 3GC treatments, intravenous vs. oral AMC, patients with multi-lobar infection, patients aged ≥65 years old, and patients with CURB65 scores of 3-4). Results: We included 200 patients from the original trial, with 93/200 (46.5%) patients only treated with intravenous treatment and 107/200 (53.5%) patients only treated with oral therapy. The failure rate at Day 15 was not significantly different among patients treated with initial intravenous vs. oral treatment [25/93 (26.9%) vs. 28/107 (26.2%), adjusted odds ratios (aOR) 0.973 (95% CI 0.519-1.823), p 0.932)]. Failure rates at Day 15 were not significantly different among the subgroup populations. Discussion: Among hospitalized patients with CAP, there was no significant difference in efficacy between initial intravenous and exclusive oral treatment. Trial Registration: This trial is registered with ClinicalTrials.gov, NCT01963442. (Copyright © 2024 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu