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Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia

医学 肺炎 内科学 社区获得性肺炎 优势比 单变量分析 人口 阿莫西林 安慰剂 肺炎严重指数 随机对照试验 临床试验 抗生素 外科 多元分析 病理 替代医学 环境卫生 微生物学 生物
作者
Aurélien Dinh,Clara Duran,Jacques Ropers,Frédérique Bouchand,Benjamin Davido,Laurène Deconinck,Morgan Matt,Olivia Sénard,Aurore Lagrange,Guillaume Mellon,Ruxandra Câlin,S. Makhloufi,Victoire de Lastours,Emmanuel Mathieu,Jean‐Emmanuel Kahn,É. Rouveix,J. Grenet,Jennifer Dumoulin,Thierry Chinet,Marion Pépin
出处
期刊:JAMA network open [American Medical Association]
卷期号:4 (10): e2129566-e2129566 被引量:14
标识
DOI:10.1001/jamanetworkopen.2021.29566
摘要

Failure of treatment is the most serious complication in community-acquired pneumonia (CAP).To assess the potential risk factors for treatment failure in clinically stable patients with CAP.This secondary analysis assesses data from a randomized clinical trial on CAP (Pneumonia Short Treatment [PTC] trial) conducted from December 19, 2013, to February 1, 2018. Data analysis was performed from July 18, 2019, to February 15, 2020. Patients hospitalized at 1 of 16 centers in France for moderately severe CAP who were clinically stable at day 3 of antibiotic treatment were included in the PTC trial and analyzed in the per-protocol trial population.Patients were randomly assigned (1:1) on day 3 of antibiotic treatment to receive β-lactam (amoxicillin-clavulanate [1 g/125 mg] 3 times daily) or placebo for 5 extra days.The main outcome was failure at 15 days after first antibiotic intake, defined as a temperature greater than 37.9 °C and/or absence of resolution or improvement of respiratory symptoms and/or additional antibiotic treatment for any cause. The association among demographic characteristics, baseline clinical and biological variables available (ie, at the first day of β-lactam treatment), and treatment failure at day 15 among the per-protocol trial population was assessed by univariate and multivariable logistic regressions.Overall, 310 patients were included in the study; this secondary analysis comprised 291 patients (174 [59.8%] male; mean [SD] age, 69.6 [18.5] years). The failure rate was 26.8%. Male sex (odds ratio [OR], 1.74; 95% CI, 1.01-3.07), age per year (OR, 1.03; 95% CI, 1.01-1.05), Pneumonia Severe Index score (OR, 1.01; 95% CI, 1.00-1.02), the presence of chronic lung disease (OR, 1.85; 95% CI, 1.03-3.30), and creatinine clearance (OR, 0.99; 95% CI, 0.98-1.00) were significantly associated with failure in the univariate analysis. When the Pneumonia Severe Index score was excluded to avoid collinearity with age and sex in the regression model, only male sex (OR, 1.92; 95% CI, 1.08-3.49) and age (OR, 1.02; 95% CI, 1.00-1.05) were associated with failure in the multivariable analysis.In this secondary analysis of a randomized clinical trial, among patients with CAP who reached clinical stability after 3 days of antibiotic treatment, only male sex and age were associated with higher risk of failure, independent of antibiotic treatment duration and biomarker levels. Another randomized clinical trial is needed to evaluate the impact of treatment duration in populations at higher risk for treatment failure.
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