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20th October 2021
Treatment failure in patients with community-acquired pneumonia (CAP) who are deemed clinically stable is associated with being male and age, according to a study by a team from the Infectious Disease Unit, Raymond-Poincare University Hospital, Paris, France. Treatment failure rates in CAP have been found to range between 2.4 and 31% among hospitalised patients and it is a serious complication that is associated with high morbidity and mortality rates. Nevertheless, once CAP patients achieve clinical stability, deterioration is much less likely as witnessed by a study of nearly 700 adults hospitalised with CAP which found that less than 1% worsened once stable.
Shorter antibiotic treatment courses for those hospitalised with CAP have the potential to reduce antibiotic resistance, adverse events and related costs. In a recent trial, the Paris team undertook a double-blind, randomised, placebo-controlled trial, the Pneumonia Short Treatment (PTC), among adult patients admitted to hospital with moderately severe CAP. The purpose of the trial was to determine whether there was a need for an additional 5-day course of β-lactam antibiotic treatment in CAP patients who were clinically stable after 3 days of treatment. The study’s primary outcome was cure, 15 days after the first antibiotic intake, defined by apyrexia, resolution or improvement of respiratory symptoms and no additional antibiotic treatment for any cause. The results showed that discontinuing β-lactam treatment after 3 days was non-inferior to 8 days of treatment.
For their latest study, the team performed a secondary analysis of data from the PTC trial to examine the factors associated with treatment failure. Details of the patient population, outcome measures etc were provided in the PTC study publication.
The PTC trial included 310 patient and the secondary analysis comprised 291 of these patients with a mean age of 69.6 years (59.8% male). The overall treatment failure rate was 26.8% (78 patients) and mainly due to a lack of symptom resolution (79.5%), including purulent sputum. dyspnoea and cough. Other causes of treatment failure were the need for additional antibiotics (10.2%) and fever at day 15 (5.1%).
Multivariate analysis revealed that male gender was significantly associated with treatment failure (odds ratio, OR = 1.92, 95% CI 1.08 – 3.49, p = 0.03) as was age (OR = 1.02, 95% CI 1.0 – 1.05, p = 0.03). This latter result was not surprising given that the mean age of those in the failure group was 76.2 years compared to 67.2 years in the cure group (p = 0.01). Interestingly, as noted in the original PTC study, the duration of antibiotic therapy had no impact on treatment failure.
The authors concluded that among clinically stable patients with CAP who received a 3-day course of antibiotics, only age and male gender, not disease severity or co-morbidities, were significantly associated with treatment failure. They suggested that these results should be taken into account in the treatment of those with CAP.
Dinh A et al.Factors Associated With Treatment Failure in Moderately Severe Community-Acquired Pneumonia. A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open 2021