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Prospective randomized comparison study of piperacillin/tazobactam and meropenem for healthcare-associated pneumonia in Japan

  • Original Article
  • Published:
Journal of Infection and Chemotherapy

Abstract

Healthcare-associated pneumonia (HCAP) may have a more severe course than community-acquired pneumonia (CAP); hence, it is more likely to be caused by drug-resistant bacterial pathogens and anaerobes involved in aspiration pneumonia. We compared the efficacy and safety of initial empiric therapy with piperacillin/tazobactam (PIPC/TAZ, 13.5 g/day) with that of meropenem (MEPM, 1.5 g/day) as single broad-spectrum regimens with gram-negative and anaerobic coverage in patients with HCAP in Japan. The clinical cure rate was 75.9 % (22/29 cases) in the PIPC/TAZ group and 64.3 % (18/28 cases) in the MEPM group. The clinical efficacy rate was 87.9 % (29/33 cases) in the PIPC/TAZ group and 74.2 % (23/31 cases) in the MEPM group. The bacteriological eradication rate was 94.4 % (17/18) in the PIPC/TAZ group and 87.5 % (14/16) in the MEPM group. Adverse drug reactions were seen in 22.4 % (11/49 cases) of patients in the PIPC/TAZ group and 17.4 % (8/46 cases) of patients in the MEPM group. Although not statistically different, the PIPC/TAZ group had a slightly higher efficacy rate than the MEPM group. Both treatment regimens are tolerable and might be appropriate to use as initial empiric therapy for HCAP in Japan. To investigate the differences in efficacy profiles of those two regimens, a further confirmatory study with a larger cohort as determined by a power analysis is recommended.

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References

  1. Ministry of Health, Labour and Welfare. http://www.mhlw.go.jp/toukei/saikin/hw/jinkou/geppo/nengai11/index.html. Accessed 5 June 2012 (in Japanese).

  2. The Japanese Respiratory Society. Guidelines for the management of nursing and health care-associated pneumonia. Tokyo: The Japanese Respiratory Society; 2011 (in Japanese).

  3. The American Thoracic Society and the Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and health care-associated pneumonia. Am J Respir Crit Care Med. 2005;171:388–416.

    Article  Google Scholar 

  4. Kollef MH, Shorr A, Tabak YP, Gupta V, Liu LZ, Johannes RS. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest. 2005;128:3854–62.

    Article  PubMed  Google Scholar 

  5. Micek ST, Kollef KE, Reichley RM, Roubinian N, Kollef MH. Health care-associated pneumonia and community-acquired pneumonia: a single-center experience. Antimicrob Agents Chemother. 2007;51:3568–73.

    Article  PubMed  CAS  Google Scholar 

  6. Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Hashimoto N, et al. Health-care-associated pneumonia among hospitalized patients in a Japanese community hospital. Chest. 2009;135:633–40.

    Article  PubMed  Google Scholar 

  7. Teramoto S, Kawashima M, Komiya K, Shoji S. Health-care-associated pneumonia is primarily due to aspiration pneumonia. Chest. 2009;136:1702–3.

    Article  PubMed  Google Scholar 

  8. Gaynes R. Health-care associated bloodstream infections: a change in thinking. Ann Intern Med. 2002;137:850–1.

    PubMed  Google Scholar 

  9. Kollef MH. Inadequate antimicrobial treatment: an important determinant of outcome for hospitalized patients. Clin Infect Dis. 2000;31:S131–8.

    Article  PubMed  Google Scholar 

  10. Kett DH, Cano E, Quartin AA, Manqino JE, Zervos MJ, Peyrani P, et al. Implementation of guidelines for management of possible multidrug-resistant pneumonia in intensive care: an observational, multicentre cohort study. Lancet Infect Dis. 2011;11:181–9.

    Article  PubMed  Google Scholar 

  11. Brito V, Niderman MS. Healthcare-associated pneumonia is a heterogeneous disease, and all patients do not need the same broad-spectrum antibiotic therapy as complex nosocomial pneumonia. Curr Opin Infect Dis. 2009;22:316–25.

    Article  PubMed  Google Scholar 

  12. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med. 1997;336:243–50.

    Article  PubMed  CAS  Google Scholar 

  13. Saito A, Miki F, Oizumi K, Rikitomi N, Watanabe A, Koga H, et al. Clinical evaluation methods for new antimicrobial agents to treat respiratory infections: report of the committee for respiratory system, Japan Society of Chemotherapy. J Infect Chemother. 1999;5:110–23.

    Article  PubMed  Google Scholar 

  14. Jaccard C, Troillet N, Harbarth S, Zanetti G, Aymon D, Schneider R, et al. Prospective randomized comparison of imipenem–cilastatin and piperacillin–tazobactam in nosocomial pneumonia or peritonitis. Antimicrob Agents Chemother. 1998;42:2966–72.

    PubMed  CAS  Google Scholar 

  15. Joshi M, Bernstein J, Solomkin J, Wester BA, Kuye O. Piperacillin/tazobactam Nosocomial Pneumoniae Study Group: piperacillin/tazobactam plus tobramycin versus ceftazidime plus tobramycin for the treatment of patients with nosocomial lower respiratory tract infection. J Antimicrob Chemother. 1999;43:389–97.

    Article  PubMed  CAS  Google Scholar 

  16. Joshi M, Metzler M, McCarthy M, Olvey S, Kassira W, Cooper A. Comparison of piperacillin/tazobactam and imipenem/cilastatin, both in combination with tobramycin, administered every 6 h for treatment of nosocomial pneumoniae. Respir Med. 2006;100:1554–65.

    Article  PubMed  Google Scholar 

  17. Carratalà J, Mykietiuk A, Fernández-Sabé N, Suárez C, Dorca J, Verdaquer R, et al. Health care-associated pneumonia requiring hospital admission: epidemiology, antibiotic therapy, and clinical outcomes. Arch Intern Med. 2007;167:1393–9.

    Article  PubMed  Google Scholar 

  18. Venditti M, Falcone M, Corrao S, Licata G, Serra P, Study Group of Italian Society of Internal Medicine. Outcomes of patients hospitalized with community-acquired, health care-associated, and hospital-acquired pneumonia. Ann Intern Med. 2009;150:19–26.

    PubMed  Google Scholar 

  19. Beardsley JR, Williamson JC, Johnson JW, Ohl CA, Karchmer TB, Bowton DL. Using local microbiologic data to develop institution-specific guidelines for the treatment of hospital-acquired pneumonia. Chest. 2006;130:787–93.

    Article  PubMed  Google Scholar 

  20. Taisho Toyama Pharmaceutical Co., Ltd. Zosyn® package insert. Revised in September 2012.

  21. Dainippon Sumitomo Pharma Co., Ltd. Meropen® package insert. Revised in January 2012.

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Acknowledgments

This study was funded by the non-profit organization, Nagasaki Evaluation Organization for Clinical Interventions (NEOCI).

Conflict of interest

Shigeru Kohno has received honoraria, lecture fees, and research grants for activities other than this trial from Taisho-Toyama Pharma Co., Ltd. and Dainippon Sumitomo Pharma Co., Ltd. No other co-authors declare any conflicts of interest.

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Authors and Affiliations

  1. Department of Molecular Microbiology and Immunology, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan

    Yoshihiro Yamamoto, Koichi Izumikawa, Shigeki Nakamura, Yoshifumi Imamura, Taiga Miyazaki, Hiroshi Kakeya & Shigeru Kohno

  2. Department of Clinical Infectious Diseases, Graduate School of Medicine and Pharmaceutical Sciences, Toyama University, Toyama, Japan

    Yoshihiro Yamamoto

  3. Department of Clinical Laboratory, Nagasaki University Hospital, Nagasaki, Japan

    Yoshitomo Morinaga & Katsunori Yanagihara

  4. Infection Control and Education Center, Nagasaki University Hospital, Nagasaki, Japan

    Shintaro Kurihara, Misuzu Tsukamoto & Akira Yasuoka

Authors
  1. Yoshihiro Yamamoto
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  2. Koichi Izumikawa
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  3. Yoshitomo Morinaga
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  4. Shigeki Nakamura
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  5. Shintaro Kurihara
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  6. Yoshifumi Imamura
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  7. Taiga Miyazaki
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  8. Misuzu Tsukamoto
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  9. Hiroshi Kakeya
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  10. Katsunori Yanagihara
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  11. Akira Yasuoka
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  12. Shigeru Kohno
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Corresponding author

Correspondence to Yoshihiro Yamamoto.

Appendix: Participating institutions and chief investigator of this study

Appendix: Participating institutions and chief investigator of this study

Japanese Red Cross Nagasaki Genbaku Isahaya Hospital (Kiyoyasu Fukushima), Japanese Red Cross Nagasaki Genbaku Hospital (Koji Hashiguchi), Isahaya Health-Insurance General Hospital (Yuichi Inoue), Sasebo City General Hospital (Yuichi Fukuda), Senju Hospital (Hikaru Tanaka), Sasebo Chuo Hospital (Tsutomu Kobayashi), Hokusho Central Hospital (Yasuhito Higashiyama), National Hospital Organization Nagasaki Medical Center (Eisuke Sasaki), Nagasaki Municipal Hospital (Naofumi Suyama), Nagasaki Municipal Medical Center (Yoji Futsuki), Saiseikai Nagasaki Hospital (Keiko Iida), Izumikawa Hospital (Yoshihisa Kohno), Nagasaki Goto Chuoh Hospital (Hideki Ikeda), all in Nagasaki, and National Hospital Organization Ureshino Medical Center (Toyomitsu Sawai), Saga, Japan.

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Yamamoto, Y., Izumikawa, K., Morinaga, Y. et al. Prospective randomized comparison study of piperacillin/tazobactam and meropenem for healthcare-associated pneumonia in Japan. J Infect Chemother 19, 291–298 (2013). https://doi.org/10.1007/s10156-013-0552-6

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  • DOI: https://doi.org/10.1007/s10156-013-0552-6

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