Is the fluoroquinolone combination necessary for empirical antibiotic regimen in severe community-acquired pneumonia?

ABSTRACT

Objectives

This study aimed to assess whether superior clinical outcomes can be attained through piperacillin/tazobactam (TZP)+fluoroquinolone (FQ) combination therapy for severe community-acquired pneumonia (CAP) compared to TZP monotherapy.

Methods

This retrospective study was conducted at a tertiary care hospital in Korea. Adult inpatients diagnosed with pneumonia within 48 hours of hospitalization were included. Severe CAP was defined as a CURB-65 score of ≥ 3 or based on the 2007 guidelines of the Infectious Diseases Society of America/American Thoracic Society (IDSA/ATS) definition. Only patients who received either TZP and FQ combination or TZP as initial empirical therapy were included.

Results

The final analysis included 145 patients; 57.9% received combination therapy and 42.1% received monotherapy. In the combination therapy group, body mass index (20.67 ± 3.28 vs. 22.26 ± 4.80, p = 0.030) and asthma prevalence (0 vs. 8.3%, p = 0.022) were significantly higher; initial symptoms, clinical severity, and causative pathogens were not significantly different between groups. White blood cell counts (12,641.64 ± 6,544.66 vs. 12,491.67 ± 10,528.24, p = 0.008), and C-reactive protein levels (18.78 ± 11.47 vs. 26.58 ± 14.97, p < 0.001) were significantly higher in the combination therapy group. Clinical outcomes, including all-cause in-hospital mortality rate (26.2 vs. 33.3%, p = 0.358), were not significantly different between the groups. Multivariate analysis identified no significant association between FQ combination and all-cause in-hospital mortality.

Conclusion

In patients with severe CAP, there were no differences in the clinical outcomes, including mortality, between the TZP and FQ combination therapy and TZP monotherapy. FQ combination was not significantly associated with in-hospital mortality.

KEYWORDS:

• Community-acquired pneumonia
• piperacillin/tazobactam
• fluoroquinolone
• empiric antibiotic therapy
• Pseudomonas aeruginosa

Acknowledgments

Seungtak Oh was a trainee of the Medical Scientist Training Program at Hanyang University College of Medicine. The abstract of this article was presented at the poster session of APCCMI 2023, Seoul, Korea.

Author contributions

Conceptualization: Kim B; Data curation: Oh S; Formal analysis: Oh S, Jang W; Investigation: Oh S, Jang W, Kim B; Methodology: Kim B; Project administration: Kim B; Resources: Kim B; Software: Oh S, Jang W; Supervision: Kim B, Jang W; Validation: Kim B; Visualization: Oh S; Writing – original draft: Oh S; Writing – review & editing: Kim B.

Data availability statement

The datasets used and/or analyzed in the current study are available from the corresponding author upon reasonable request.

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Ethics statement

This retrospective chart review was approved by the Human Investigation Committee (IRB) of Hanyang University Hospital (IRB No. 2021-05-050-004). Informed consent was waived because of the retrospective nature of the study and because the analysis used anonymous clinical data.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/00325481.2024.2347830.

Additional information

Funding

This paper was not funded.