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.

Autor:	Eynath Y; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., McNeil R; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Buchrits S; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Guz D; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Fredman D; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Gafter-Gvili A; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel., Avni T; Department of Medicine A, Beilinson Hospital, Rabin Medical Center, Petah-Tikva, Israel.; Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Jazyk:	angličtina
Zdroj:	The Journal of antimicrobial chemotherapy [J Antimicrob Chemother] 2024 Nov 04; Vol. 79 (11), pp. 3007-3015.
DOI:	10.1093/jac/dkae323
Abstrakt:	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. (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)
Databáze:	MEDLINE
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