Int J Antimicrob Agents. 2021 Dec 3:106491. doi: 10.1016/j.ijantimicag.2021.106491. Online ahead of print.
OBJECTIVES: Both cefoperazone-sulbactam (CFP-SUL) and piperacillin-tazobactam (PIP-TAZ) are β-lactam/β-lactamase inhibitor antibiotics and have a similar antimicrobial spectrum. However, comparative clinical efficacy and safety between CFP-SUL and PIP-TAZ for pneumonia treatment remain largely unknown, especially in the elderly population.
METHODS: Based on a multicenter, registry database, patients aged ≥65, diagnosed with severe community-acquired pneumonia (SCAP), hospital-acquired pneumonia (HAP), or ventilator-associated pneumonia (VAP), and given empirical therapy with CFP-SUL or PIP-TAZ were included for analysis. The primary outcome of interest was the proportion of patients achieving clinical cure. Multivariate logistic regression was conducted to compare the odds ratios (OR) for the outcome between patients received CFP-SUL and PIP-TAZ.
RESULTS: A total of 941 elderly patients, 624 with SCAP and 317 with either HAP or VAP, were included. The overall in-hospital mortality for the entire cohort was 19%. Clinical cure can be achieved in 81% and 83% of patients with SCAP and HAP/VAP, respectively. Multivariate logistic regression analysis showed similar odds for clinical cure between patients receiving CFP-SUL and PIP-TAZ whether they had SCAP (adjusted OR, 1.10; 95% CI, 0.71-1.70) or HAP/VAP (adjusted OR, 0.72; 95% CI, 0.30-1.76). Regarding the safety issue, both CFP-SUL and PIP-TAZ were generally well tolerated with few reported adverse events, even in this aged population.
CONCLUSIONS: Among the elderly patients with SCAP or HAP/VAP, empirical therapy with CFP-SUL is a viable alternative to PIP-TAZ, while considering antibiotic heterogeneity in antimicrobial stewardship.