Clinical Efficacy of Cefoperazone-Sulbactam versus Piperacillin-Tazobactam in the Treatment of Hospital-Acquired Pneumonia and Ventilator-Associated Pneumonia

Figures & data

Table 1 Demographic Characteristics of the Patients Receiving Cefoperazone-Sulbactam and Piperacillin-Tazobactam

Variable	Cefoperazone-Sulbactam, n = 209	Piperacillin-Tazobactam, n = 201	p
Age	75.1±14.8	74.6±16.6	0.794
Sex			0.671
Male	141 (67.5)	140 (69.7)
Female	68 (32.5)	61 (30.3)
Type of infection			0.344
Hospital-acquired pneumonia	172 (82.3)	173 (86.1)
Ventilator-associated pneumonia	37 (17.7)	28 (13.9)
Underlying disease
Dementia	91 (43.5)	38 (18.9)	<0.001
Diabetes mellitus	65 (31.1)	80 (39.8))	0.079
Chronic pulmonary disease	56 (26.8)	48 (23.9)	0.570
Congestive heart failure	45 (21.5)	32 (15.9)	0.165
Stroke	40 (19.1)	14 (7.0)	<0.001
Peptic ulcer disease	33 (15.8)	23 (11.4)	0.250
Myocardial infarction	31 (14.8)	13 (6.5)	0.007
Chronic kidney disease	27 (12.9)	31 (15.4)	<0.001
Solid cancer	18 (8.6)	17 (8.5)	>0.999
Chronic liver disease	18 (8.6)	11 (5.5)	0.250
Peripheral vascular disease	11 (5.3)	4 (2.0)	0.113
Charlson score	6.5±2.9	5.7±2.7	<0.001
APACHE II score	21.4±6.2 (n = 171)	19.3±6.0 (n = 109)	0.002
SOFA score	5.3±2.9 (n = 171)	5.8±3.5 (n = 112)	0.257

Table 2 Microbiological Distribution of Major Pathogens

Pathogens	No (%) of Pathogen
	All		Hospital-Acquired Pneumonia		Ventilator-Associated Pneumonia
	Cefoperazone-Sulbactam, n = 209	Piperacillin-Tazobactam, n = 201	Cefoperazone-Sulbactam, n = 172	Piperacillin-Tazobactam, n = 173	Cefoperazone-Sulbactam, n = 37	Piperacillin-Tazobactam, n = 28
Pseudomonas aeruginosa	38 (18.2)	19 (9.5)	34 (19.8)	14 (8.1)	4 (10.8)	5 (17.9)
Acinetobacter spp.	36 (17.2)	18 (9.0)	22 (12.8)	17 (9.8)	14 (37.8)	1 (3.6)
Klebsiella pneumoniae	32 (15.3)	13 (6.5)	29 (16.9)	10 (5.8)	3 (3.0)	3 (10.7)
Escherichia coli	10 (4.8)	7 (3.5)	10 (5.8)	7 (4.0)	0 (0)	0 (0)
Streptococcus spp.	7 (3.3)	12 (6.0)	5 (2.9)	12 (6.9)	2 (5.4)	0 (0)

Table 3 Clinical Outcomes Between Cefoperazone-Sulbactam and Piperacillin-Tazobactam Groups

Variable	Cefoperazone-Sulbactam, n = 209	Piperacillin-Tazobactam, n = 201	p
Primary outcome			0.943
Clinical cure	169 (80.9)	161 (80.1)
Failure	36 (17.2)	37 (18.4)
Indeterminate	4 (1.9)	3 (1.5)
Secondary outcome			0.711
Effective	169 (80.9)	162 (80.6)
Ineffective	37 (17.7)	38 (18.9)
Indeterminate	3 (1.4)	1 (0.5)
In-hospital mortality
All-cause mortality	50 (23.9)	42 (20.9)	0.480
Pneumonia related	27 (12.9)	18 (9.0)	0.304

Figure 1 Clinical outcome of patients receiving cefoperazone-sulbactam and piperacillin-tazobactam for hospital-acquired pneumonia (HAP) (A) and ventilator-associated pneumonia (VAP) (B).

Figure 2 All-cause mortality (A) and pneumonia-related mortality (B) of patients receiving cefoperazone-sulbactam and piperacillin-tazobactam for hospital-acquired pneumonia (HAP) and ventilator associated pneumonia (VAP).

Table 4 Outcome Analysis

	All		Hospital-Acquired Pneumonia		Ventilator-Associated Pneumonia
Variable	Crude RR (95% CI)	Adjust RR* (95% CI)	Crude RR (95% CI)	Adjust RR* (95% CI)	Crude RR (95% CI)	Adjust RR* (95% CI)
Clinical cure	1.01 (0.92, 1.11)	0.93 (0.82, 1.05)	1.00 (0.90, 1.10)	0.89 (0.77, 1.03)	1.10 (0.82, 1.46)	1.33 (0.93, 1.92)
Clinical effectiveness	1.00 (0.91, 1.10)	0.90 (0.80, 1.03)	0.98 (0.89, 1.09)	0.84 (0.73, 0.98)	1.14 0.86, 1.50)	1.33 (0.93, 1.92)
In-hospital mortality
All-cause mortality	1.14 (0.80, 1.64)	1.10 (0.65, 1.84)	1.15 (0.77, 1.70)	1.31 (0.75, 2.30)	1.14 (0.46, 2.82)	0.60 (0.17, 2.14)
Pneumonia related	1.26 (0.82, 1.94)	1.01 (0.51, 2.00)	1.19 (0.77, 1.84)	0.76 (0.40, 1.47)	2.67 (0.39, 18.42)	1.67 (0.16, 17.89)

Note: *Adjusted APACHE II and Charlson score using propensity score matching.