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Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database
Studies indicated potential harm from empirical broad-spectrum therapy. A recent study of hospitalizations for community-acquired pneumonia suggested that empirical anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy was associated with an increased risk of death and other complications....
Autores principales: | , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456764/ https://www.ncbi.nlm.nih.gov/pubmed/37630465 http://dx.doi.org/10.3390/microorganisms11081905 |
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author | Koga, Satoru Takazono, Takahiro Kido, Takashi Muramatsu, Keiji Tokutsu, Kei Tokito, Takatomo Okuno, Daisuke Ito, Yuya Yura, Hirokazu Takeda, Kazuaki Iwanaga, Naoki Ishimoto, Hiroshi Sakamoto, Noriho Yatera, Kazuhiro Izumikawa, Koichi Yanagihara, Katsunori Fujino, Yoshihisa Fushimi, Kiyohide Matsuda, Shinya Mukae, Hiroshi |
author_facet | Koga, Satoru Takazono, Takahiro Kido, Takashi Muramatsu, Keiji Tokutsu, Kei Tokito, Takatomo Okuno, Daisuke Ito, Yuya Yura, Hirokazu Takeda, Kazuaki Iwanaga, Naoki Ishimoto, Hiroshi Sakamoto, Noriho Yatera, Kazuhiro Izumikawa, Koichi Yanagihara, Katsunori Fujino, Yoshihisa Fushimi, Kiyohide Matsuda, Shinya Mukae, Hiroshi |
author_sort | Koga, Satoru |
collection | PubMed |
description | Studies indicated potential harm from empirical broad-spectrum therapy. A recent study of hospitalizations for community-acquired pneumonia suggested that empirical anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy was associated with an increased risk of death and other complications. However, limited evidence supports empirical anti-MRSA therapy for older patients with aspiration pneumonia. In a nationwide Japanese database, patients aged ≥65 years on admission with aspiration pneumonia were analyzed. Patients were divided based on presence of respiratory failure and further sub-categorized based on their condition within 3 days of hospital admission, either receiving a combination of anti-MRSA agents and other antibiotics, or not using MRSA agents. An inverse probability weighting method with estimated propensity scores was used. Out of 81,306 eligible patients, 55,098 had respiratory failure, and 26,208 did not. In the group with and without respiratory failure, 0.93% and 0.42% of the patients, respectively, received anti-MRSA agents. In patients with respiratory failure, in-hospital mortality (31.38% vs. 19.03%, p < 0.001), 30-day mortality, and 90-day mortality were significantly higher, and oxygen administration length was significantly longer in the anti-MRSA agent combination group. Anti-MRSA agent combination use did not improve the outcomes in older patients with aspiration pneumonia and respiratory failure, and should be carefully and comprehensively considered. |
format | Online Article Text |
id | pubmed-10456764 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-104567642023-08-26 Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database Koga, Satoru Takazono, Takahiro Kido, Takashi Muramatsu, Keiji Tokutsu, Kei Tokito, Takatomo Okuno, Daisuke Ito, Yuya Yura, Hirokazu Takeda, Kazuaki Iwanaga, Naoki Ishimoto, Hiroshi Sakamoto, Noriho Yatera, Kazuhiro Izumikawa, Koichi Yanagihara, Katsunori Fujino, Yoshihisa Fushimi, Kiyohide Matsuda, Shinya Mukae, Hiroshi Microorganisms Article Studies indicated potential harm from empirical broad-spectrum therapy. A recent study of hospitalizations for community-acquired pneumonia suggested that empirical anti-methicillin-resistant Staphylococcus aureus (MRSA) therapy was associated with an increased risk of death and other complications. However, limited evidence supports empirical anti-MRSA therapy for older patients with aspiration pneumonia. In a nationwide Japanese database, patients aged ≥65 years on admission with aspiration pneumonia were analyzed. Patients were divided based on presence of respiratory failure and further sub-categorized based on their condition within 3 days of hospital admission, either receiving a combination of anti-MRSA agents and other antibiotics, or not using MRSA agents. An inverse probability weighting method with estimated propensity scores was used. Out of 81,306 eligible patients, 55,098 had respiratory failure, and 26,208 did not. In the group with and without respiratory failure, 0.93% and 0.42% of the patients, respectively, received anti-MRSA agents. In patients with respiratory failure, in-hospital mortality (31.38% vs. 19.03%, p < 0.001), 30-day mortality, and 90-day mortality were significantly higher, and oxygen administration length was significantly longer in the anti-MRSA agent combination group. Anti-MRSA agent combination use did not improve the outcomes in older patients with aspiration pneumonia and respiratory failure, and should be carefully and comprehensively considered. MDPI 2023-07-27 /pmc/articles/PMC10456764/ /pubmed/37630465 http://dx.doi.org/10.3390/microorganisms11081905 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Koga, Satoru Takazono, Takahiro Kido, Takashi Muramatsu, Keiji Tokutsu, Kei Tokito, Takatomo Okuno, Daisuke Ito, Yuya Yura, Hirokazu Takeda, Kazuaki Iwanaga, Naoki Ishimoto, Hiroshi Sakamoto, Noriho Yatera, Kazuhiro Izumikawa, Koichi Yanagihara, Katsunori Fujino, Yoshihisa Fushimi, Kiyohide Matsuda, Shinya Mukae, Hiroshi Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database |
title | Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database |
title_full | Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database |
title_fullStr | Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database |
title_full_unstemmed | Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database |
title_short | Evaluation of the Effectiveness and Use of Anti-Methicillin-Resistant Staphylococcus aureus Agents for Aspiration Pneumonia in Older Patients Using a Nationwide Japanese Administrative Database |
title_sort | evaluation of the effectiveness and use of anti-methicillin-resistant staphylococcus aureus agents for aspiration pneumonia in older patients using a nationwide japanese administrative database |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10456764/ https://www.ncbi.nlm.nih.gov/pubmed/37630465 http://dx.doi.org/10.3390/microorganisms11081905 |
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