title: Multivariate analysis of prognostic factors in patients with pulmonary actinomycosis.
abstract: BACKGROUND
  There have been few studies of pulmonary actinomycosis, which is an uncommon anaerobic infection. Consequently, the optimal therapeutic regimen, appropriate duration of treatment, long-term prognosis, and factors predicting prognosis are not well established.
  
  
  METHODS
  We retrospectively reviewed the medical records of histopathologically confirmed cases of pulmonary actinomycosis seen between November 2003 and December 2012.
  
  
  RESULTS
  The study included 68 patients with a mean age of 58.4 ± 11.6 years. Of the 68, initial surgery was performed in 15 patients (22.1%), while the remaining 53 (77.9%) received antibiotic therapy initially. In the initial antibiotic group, 45/53 (84.9%) were cured without relapse (median antibiotic duration 5.3 months). 5/53 (9.4%) patients were refractory medically (median antibiotic duration 9.7 months), and 3/53 (5.7%) experienced a recurrence (median time to relapse 35.3 months). In the initial surgery group, 14/15 (93.3%) were cured and treatment failure occurred in one (6.7%). In the multivariate analysis, the absence of an antibiotic response at 1 month was the only independent factor associated with a poor treatment outcome, with an adjusted odds ratio of 49.2 (95% CI, 3.34-724.30). There was no significant difference in treatment outcome based on the size of the parenchymal lesion, comorbidities, whether intravenous antibiotics were used, antibiotic therapy duration, or whether the initial treatment was surgical.
  
  
  CONCLUSIONS
  Antibiotic treatment with or without surgery was effective for treatment of pulmonary actinomycosis. Nevertheless, treatment failure or recurrence occurred in a considerable proportion of patients, especially those resistant to the initial antibiotic treatment.
authors.forename: Ji Young
authors.initials: JY
authors.lastname: Park
authors.forename: Taehoon
authors.initials: T
authors.lastname: Lee
authors.forename: Hongyeul
authors.initials: H
authors.lastname: Lee
authors.forename: Hyo-Jeong
authors.initials: HJ
authors.lastname: Lim
authors.forename: Jinwoo
authors.initials: J
authors.lastname: Lee
authors.forename: Jong Sun
authors.initials: JS
authors.lastname: Park
authors.forename: Young-Jae
authors.initials: YJ
authors.lastname: Cho
authors.forename: Young Sik
authors.initials: YS
authors.lastname: Park
authors.forename: Chang-Hoon
authors.initials: CH
authors.lastname: Lee
authors.forename: Sang-Min
authors.initials: SM
authors.lastname: Lee
authors.forename: Ho Il
authors.initials: HI
authors.lastname: Yoon
authors.forename: Jae-Joon
authors.initials: JJ
authors.lastname: Yim
authors.forename: Chul-Gyu
authors.initials: CG
authors.lastname: Yoo
authors.forename: Young Whan
authors.initials: YW
authors.lastname: Kim
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Han
authors.forename: Choon-Taek
authors.initials: CT
authors.lastname: Lee
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea. jhlee7@snubh.org.
authors.forename: Jae Ho
authors.initials: JH
authors.lastname: Lee
mesh_terms: D000196:Actinomycosis / Q000175:diagnosis / Q000188:drug therapy*; D061605:Administration, Intravenous; D000284:Administration, Oral; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008171:Lung Diseases / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents