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Superinfection associated with prolonged antibiotic use in non-ventilator associated hospital-acquired pneumonia

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Abstract

Background Non-ventilator associated hospital-acquired pneumonia accounts for significant antibiotic use and is associated with a high rate of resistance emergence. However, the optimal duration of antibiotic treatment is uncertain, especially in cases of non-fermenting gram-negative bacilli. Objective To compare a short course (5–7 days) to a prolonged course (10–14 days) of antibiotics for non-ventilator associated hospital-acquired pneumonia. Methods Data collected retrospectively on patients completed treatment in a Malaysian tertiary hospital from January 2017 till December 2018. Regression analysis determined variables independently associated with clinical outcome. Main outcome measures Clinical resolution, superinfection, 30-day and 90-day all-cause mortality between short and prolonged courses. Results Of the 167 patients included, 112 patients were treated with a short course antibiotic, whereas 55 patients received a prolonged course of therapy. Neither short nor prolonged course group has a significantly higher rate of clinical resolution. Short course group had significantly higher mean ± SD antibiotic-free days (21.9 ± 3.5 versus 15.1 ± 6.2 days, p < 0.001). Higher rate of superinfection was observed in prolonged course group compared to short course group (6.3% versus 18.2%, p = 0.027). For non-ventilator associated hospital-acquired pneumonia caused by non-fermenting gram-negative bacilli, the superinfection rate was higher in prolonged course group (35.7% versus 15.4%, p = 0.385) while 30-day mortality rate was higher in the short course group (38.5% versus 14.3%, p = 0.209). Non-fermenting gram-negative bacilli cause higher rate of superinfection (p = 0.010). Conclusion We found no clinical benefit as defined by clinical resolution and reduction in all-cause mortality in prolonging antimicrobial therapy. Superinfections emerge more frequently in prolonged course of antibiotic therapy and more likely to develop in non-fermenting gram-negative bacilli.

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Abbreviations

AOR:

At own risk

APACHE II:

Acute Physiologic and Chronic Health Evaluation II

CHF:

Congestive heart failure

COAD:

Chronic obstructive airway disease

CPIS:

Clinical Pulmonary Infection Score

CRP:

C-reactive protein

DM:

Diabetes mellitus

ESRF:

End-stage renal failure

GOLD:

Global Initiative for Chronic Obstructive Lung Disease

HAP:

Hospital-acquired pneumonia

IV:

Intravenous

MRSA:

Methicillin-resistant Staphylococcus aureus

MSSA:

Methicillin-susceptible Staphylococcus aureus

NF-GNB:

Non-fermenting gram-negative bacilli

NV-HAP:

Non-ventilator associated hospital-acquired pneumonia

SOFA:

Sequential Organ Failure Assessment

VAP:

Ventilator-associated pneumonia

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Acknowledgements

The authors would like to thank the Director General of Health Malaysia for his permission to publish this article. We are grateful to Nur Elya Shakirah and Siti Masuri for their involvement in assisting this study.

Funding

This research did not receive any specific grant from funding agencies in public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Pharmacy, Hospital Sultan Haji Ahmad Shah, Ministry of Health, Pahang, Malaysia

    Ying Xian Tan & Gah Wai Wong

  2. Department of Genito-Urinary & HIV Medicine, Barts Health NHS Trust, Royal London Hospital, London, UK

    Ying Huan Tan

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  1. Ying Xian Tan
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  2. Gah Wai Wong
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Correspondence to Ying Xian Tan.

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Tan, Y.X., Wong, G.W. & Tan, Y.H. Superinfection associated with prolonged antibiotic use in non-ventilator associated hospital-acquired pneumonia. Int J Clin Pharm 43, 1555–1562 (2021). https://doi.org/10.1007/s11096-021-01282-7

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