Ampicillin-sulbactam versus third-generation cephalosporins in aspiration Pneumonia: A nationwide retrospective cohort study

Abstract

Background: This study aims to evaluate the clinical outcomes of ampicillin-sulbactam versus third-generation cephalosporins (e.g., ceftriaxone or cefotaxime) in managing aspiration pneumonia.

Methods: We utilized the Diagnosis Procedure Combination (DPC) database, a comprehensive national inpatient database in Japan, to identify patients diagnosed with aspiration pneumonia between July 2010 and March 2022. Patients were categorized into two groups based on their treatment: those receiving ampicillin-sulbactam and those receiving third-generation cephalosporins (either ceftriaxone or cefotaxime). To mitigate confounding factors, propensity score overlap weighting analysis was employed to compare in-hospital mortality rates and the incidence of Clostridioides difficile infection between the two treatment groups.

Results: Among the 548,972 eligible patients, 424,446 received ampicillin-sulbactam, while 124,526 were treated with third-generation cephalosporins. In the third-generation cephalosporin group, 97.7 % of patients were administered ceftriaxone, and 2.3 % received cefotaxime. The mean treatment duration was 8.5 days (standard deviation [SD] 4.3) in the ampicillin-sulbactam group and 7.9 days (SD 4.1) in the third-generation cephalosporin group. Propensity score overlap weighting analysis revealed that patients treated with ampicillin-sulbactam had significantly lower in-hospital mortality (14.6 % vs. 16.4 %; risk difference [RD], -1.8 %; 95 % confidence interval [CI], -2.1 % to -1.5 %; P < 0.001) and a lower incidence of C. difficile infection (2.0 % vs. 2.8 %; RD, -0.8 %; 95 % CI, -0.9 % to -0.7 %; P < 0.001) compared to those treated with third-generation cephalosporins.

Conclusion: Our findings suggest that ampicillin-sulbactam was associated with lower in-hospital mortality and a reduced incidence of C. difficile infection compared to third-generation cephalosporins in patients with aspiration pneumonia.

Keywords: Ampicillin-sulbactam; Aspiration pneumonia; Cefotaxime; Ceftriaxone; Cephalosporin.