title: Retrospective investigation of the clinical effects of tazobactam/piperacillin and sulbactam/ampicillin on aspiration pneumonia caused by Klebsiella pneumoniae.
abstract: Klebsiella pneumoniae is an important causative bacterium of aspiration pneumonia in many elderly patients. We retrospectively investigated the clinical effects of the early treatment of aspiration pneumonia and background factors in 24 patients from whom Klebsiella pneumoniae was isolated. Sulbactam/ampicillin (SBT/ABPC) was selected for early treatment in 12 of the 24 patients diagnosed with aspiration pneumonia, and tazobactam/piperacillin (TAZ/PIPC) was selected for the other patients. The effective rates and success rates of early treatment were significantly higher in the TAZ/PIPC group than in the SBT/ABPC group (p = 0.003 and 0.027, respectively). Although no significant difference was noted because of the limited number of cases, the survival rates after 30 days were 91.7 and 58.3 % in the TAZ/PIPC and SBT/ABPC groups, respectively. Several bacteria isolated with Klebsiella pneumoniae were resistant bacteria, such as methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa, and no anaerobe or extended-spectrum β-lactamase-producing Klebsiella pneumoniae was isolated. Thirteen and 11 of the 24 cases were classified as healthcare-associated pneumonia (HCAP) and hospital-acquired pneumonia (HAP), respectively, with no case classified as community-acquired pneumonia (CAP). As population aging progresses, the frequency of aspiration pneumonia classified as HCAP will increase. To cover anaerobes, it is necessary to select antibacterial drugs, such as TAZ/PIPC, for early treatment in consideration of resistant gram-negative bacteria to improve the outcome, and not drugs with weak activity against these bacteria.
authors.affiliation: Department of Respiratory Medicine/Infectious Disease, Niigata City General Hospital, 463-7 Shumoku, Chuo-ku, Niigata, 950-1197, Japan. htsukada@hosp.niigata.niigata.jp
authors.forename: Hiroki
authors.initials: H
authors.lastname: Tsukada
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Sakai
authors.forename: Hiromi
authors.initials: H
authors.lastname: Cho
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kimura
authors.forename: Takafumi
authors.initials: T
authors.lastname: Tetsuka
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Nakajima
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Ito
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000667:Ampicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification; D002097:C-Reactive Protein / Q000378:metabolism; D004359:Drug Therapy, Combination; D006801:Humans; D008875:Middle Aged; D010397:Penicillanic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010878:Piperacillin / Q000627:therapeutic use; D000077725:Piperacillin, Tazobactam Drug Combination; D011015:Pneumonia, Aspiration / Q000188:drug therapy* / Q000378:metabolism / Q000382:microbiology; D012189:Retrospective Studies; D013407:Sulbactam / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000077725:Piperacillin, Tazobactam Drug Combination; C035444:sultamicillin; D000667:Ampicillin; D010397:Penicillanic Acid; D002097:C-Reactive Protein; D013407:Sulbactam; D010878:Piperacillin