Investigation of antimicrobial therapy for aspiration pneumonia in elderly nursing homes: a retrospective observational study in Japan
Main Article Content
Keywords
Aspiration pneumonia, Elderly nursing home, Practice guidelines, Japan
Abstract
Objective: Poor prognostic factors in the treatment of infectious diseases in home care have not been studied to date. Further, there have been no studies on the appropriate use of antimicrobial agents for aspiration pneumonia in elderly nursing home. Therefore, this study was retrospectively investigated the status of antimicrobial use for aspiration pneumonia in elderly nursing homes, and the clinical efficacy of each antimicrobial therapy. Methods: Patients who received antimicrobial therapy for aspiration pneumonia between 2020 and 2022 were included. This study was investigated the compliance of antimicrobial therapy with recommended Japanese guidelines. The clinical efficacy and safety of the recommended and non-recommended antimicrobial therapies were examined. Results: Fifty patients with aspiration pneumonia were administered antimicrobials. The rate of compliance to the guidelines for the appropriate selection, dose, and duration of antimicrobials were 46%, 66%, and 66%. This investigation indicated that all three indicators were appropriate showed a higher clinical cure rate and lower mortality rate than those in groups for which all three indicators were inadequate (clinical cure, 91.7% vs. 0%, p = 0.008; 30-days mortality, 8.3% vs. 33.3%, p = 0.371). In addition, appropriate drug selection resulted in lower mortality, and appropriate dosing duration was significantly associated with better clinical cure rates (p<0.0001). Conclusions: Overall, the appropriate use of antimicrobials according to the guidelines appears to be associated with improved clinical outcomes in the treatment of aspiration pneumonia in elderly nursing homes
References
1. Fernandez-Sabe N, Carratala J, Roson B, et al. Community-acquired pneumonia in very elderly patients: causative organisms, clinical characteristics, and outcomes. Medicine. 2003;82(3):159-169. https://doi.org/10.1097/01.md.0000076005.64510.87
2. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665-671. https://doi.org/10.1056/nejm200103013440908
3. Lanspa MJ, Jones BE, Brown SM, et al. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. 2013;8(2):83-90. https://doi.org/10.1002/jhm.1996
4. Bell BG, Schellevis F, Stobberingh E, et al. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect. 2014;14(1):13. https://doi.org/10.1186/1471-2334-14-13
5. Muraki Y, Yagi T, Tsuji Y, et al. Japanese antimicrobial consumption surveillance: First report on oral and parenteral antimicrobial consumption in Japan (2009–2013). J Glob Antimicrob Resist. 2016;7(1):19-23. https://doi.org/10.1016/j.jgar.2016.07.002
6. Yamasaki D, Tanabe M, Muraki Y, et al. The first report of Japanese antimicrobial use measured by national database based on health insurance claims data (2011–2013): Comparison with sales data, and trend analysis stratified by antimicrobial category
and age group. Infection. 2018;46(2):207-214. https://doi.org/10.1007/s15010-017-1097-x
7. American Thoracic Society Infectious Disease Society of America. Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare-associated pneumonia. Am Respir Crit Care. 2005;4(4):388-416. https://doi.
org/10.1164/rccm.200405-644st
8. Mandel LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-S72.
https://doi.org/10.1086/511159
9. Morimoto K, Suzuki M, Ishifuji T, et al. The burden and etiology of community-onset pneumonia in the aging Japanese population: a multicenter prospective study. PLoS ONE. 2015;10(3):e0122247. https://doi.org/10.1371/journal.pone.0122247
10. Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):775-787. https://
doi.org/10.1001/jama.2016.0289
11. Miyashita N, Matsushima T, Oka M. The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations. Intern Med. 2006;45(7):419-428. https://doi.org/10.2169/internalmedicine.45.1691
12. The Japanese Respiratory Society. Committee for the JRS Guidelines in Management of Pneumonia in Adults. The JRS Guidelines for the Management of Pneumonia in adults. 2017; Japanese.
13. Wunderink RG, Niederman MS, Kollef MH, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012;54:621-629. https://doi.org/10.1016/j.ymed.2012.08.055
14. Ministry of Health, Labour and Welfare. Laws and Regulations Pertaining to the Certification of Nursing care needs.. Accessed February 5, 2023.
15. Van Boeckel TP, Gandra S, Ashok A, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8):742-750. https://doi.org/10.1016/s1473-3099(14)70780-7
16. World Health Organization. WHO report on surveillance of antibiotic consumption: 2016-2018 early implementation. Geneva: WHO. 2018.. Accessed February
5, 2023.
17. Falcone M, Paul M, Yahav D, et al. Antimicrobial consumption and impact of antimicrobial stewardship programmes in longterm care facilities. Clin Microbiol Infect. 2019;25(5):562-569. https://doi.org/10.1016/j.cmi.2018.07.028
18. Brown KA, Chambers A, MacFarlane S, et al. Reducing unnecessary urine culturing and antibiotic overprescribing in long-term care: a before-and-after analysis. CMAJ Open. 2019;7(1):E174-E181. https://doi.org/10.9778/cmajo.20180064
19. Marra F, McCabe M, Sharma P, et al. Utilization of Antibiotics in Long-Term Care Facilities in British Columbia, Canada. J Am Med Dir Asso. 2017;18(12):1098.e1-1098. e11. https://doi.org/10.1016/j.jamda.2017.09.018
20. Mayne S, Sundvall PD, Gunnarsson R. Confusion Strongly Associated with Antibiotic Prescribing Due to Suspected Urinary Tract Infections in Nursing Homes. J Am Geriatr Soc. 2018;66(2):274-281. https://doi.org/10.1111/jgs.15179
21. Thornley T, Ashiru-Oredope D, Normington A, et al. Antibiotic prescribing for residents in long-term-care facilities across the UK. J Antimicrob Chemother. 2019;74(5):1447-1451. https://doi.org/10.1093/jac/dkz008
22. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect
Dis. 2016;63(5):e61-111. https://doi.org/10.1093/cid/ciw353
23. Bartlett JG. How important are anaerobic bacteria in aspiration pneumonia: when should they be treated and what is optimal therapy. Infect Dis Clin North Am. 2013;27(1):149-155. https://doi.org/10.1016/j.idc.2012.11.016
24. Asai N, Ohashi W, Watanabe H, et al. Efficacy and validity of guideline-concordant treatment according to the JRS guidelines for
25. Shelley S Magill, Erin O’Leary, Kainer MA, et al. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals. JAMA Netw Open. 2021;4(3):e212007. https://doi.org/10.1001/jamanetworkopen.2021.2007
26. Madaras-Kelly KJ, Burk M, Caplinger C, et al. Pneumonia Duration of Therapy Medication Utilization Evaluation Group. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: results of a national medication
utilization evaluation. J Hosp Med. 2016;11:832-839.
27. Magill SS, O’Leary E, Ray SM, et al. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals. JAMA Netw Open. 2021;4(3):e212007. https://doi.org/10.1001/jamanetworkopen.2021.2007
28. Dean NC, Bateman KA, Donnelly SM, et al. Improved clinical outcomes with utilization of a community-acquired pneumonia guideline. Chest. 2006;130(2):794-799. https://doi.org/10.1016/j.jemermed.2006.11.012
29. Frei CR, Attridge RT, Mortensen EM, et al. Guideline-concordant antibiotic use and survival among patients with communityacquired pneumonia admitted to the intensive care unit. Clin Ther. 2010;32(2):293-299. https://doi.org/10.1016/j.
clinthera.2010.02.006
30. Menendez R, Torres A, Zalacain R, et al. Guidelines for the Treatment of Community-acquired Pneumonia: Predictors of Adherence and Outcome. Am J Respir Crit Care Med. 2005;172:757-762.
31. Tellado JM, Sen SS, Caloto MT, et al. Consequences of inappropriate initial empiric parenteral antibiotic therapy among patients with community-acquired intra-abdominal infections in Spain. Scand J Infect Dis. 2007;39(11-12):947-955. https://
doi.org/10.1080/00365540701449377
32. Marquet K, Liesenborgs A, Bergs J, et al. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care. 2015;19(1):63. https://doi.org/10.1186/s13054-015-0795-y
33. Tefera GM, Feyisa BB, Kebede TM. Antimicrobial use-related problems and their costs in surgery ward of Jimma University Medical Center: Prospective observational study. PLoS One. 2019;14(5):e0216770. https://doi.org/10.1371/journal.
pone.0216770
34. Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290:2588-2598. https://doi.org/10.1201/9780429316944-86
35. Lan SH, Lai CC, Chang SP, et al. Five-day antibiotic treatment for community-acquired bacterial pneumonia: A systematic
review and meta-analysis of randomized controlled trials. J Glob Antimicrob Resist. 2020;23:94-99. https://doi.org/10.1016/j.jgar.2020.08.005
36. Han X, Liu X, Chen L, et al. Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients. BMC Infect Dis. 2020;20(1):668. https://doi.org/10.21203/rs.3.rs-21428/v1
37. Tansarli GS, Mylonakis E. Systematic review and meta-analysis of the efficacy of short-course antibiotic treatments for community-acquired pneumonia in adults. Antimicrob Agents Chemother. 2018;62(9):e00635. https://doi.org/10.1128/
aac.00635-18
the managements of pneumonia in adults updated in 2017 for nursing and healthcare-associated pneumonia. A propensitymatching score analysis. J Infect Chemother. 2022;28(1):24-28. https://doi.org/10.1016/j.jiac.2021.09.007
2. Marik PE. Aspiration pneumonitis and aspiration pneumonia. N Engl J Med. 2001;344(9):665-671. https://doi.org/10.1056/nejm200103013440908
3. Lanspa MJ, Jones BE, Brown SM, et al. Mortality, morbidity, and disease severity of patients with aspiration pneumonia. J Hosp Med. 2013;8(2):83-90. https://doi.org/10.1002/jhm.1996
4. Bell BG, Schellevis F, Stobberingh E, et al. A systematic review and meta-analysis of the effects of antibiotic consumption on antibiotic resistance. BMC Infect. 2014;14(1):13. https://doi.org/10.1186/1471-2334-14-13
5. Muraki Y, Yagi T, Tsuji Y, et al. Japanese antimicrobial consumption surveillance: First report on oral and parenteral antimicrobial consumption in Japan (2009–2013). J Glob Antimicrob Resist. 2016;7(1):19-23. https://doi.org/10.1016/j.jgar.2016.07.002
6. Yamasaki D, Tanabe M, Muraki Y, et al. The first report of Japanese antimicrobial use measured by national database based on health insurance claims data (2011–2013): Comparison with sales data, and trend analysis stratified by antimicrobial category
and age group. Infection. 2018;46(2):207-214. https://doi.org/10.1007/s15010-017-1097-x
7. American Thoracic Society Infectious Disease Society of America. Guidelines for the management of adults with hospitalacquired, ventilator-associated, and healthcare-associated pneumonia. Am Respir Crit Care. 2005;4(4):388-416. https://doi.
org/10.1164/rccm.200405-644st
8. Mandel LA, Wunderink RG, Anzueto A, et al. Infectious diseases society of America/American thoracic society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007;44(Suppl 2):S27-S72.
https://doi.org/10.1086/511159
9. Morimoto K, Suzuki M, Ishifuji T, et al. The burden and etiology of community-onset pneumonia in the aging Japanese population: a multicenter prospective study. PLoS ONE. 2015;10(3):e0122247. https://doi.org/10.1371/journal.pone.0122247
10. Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a New Definition and Assessing New Clinical Criteria for Septic Shock: For the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). JAMA. 2016;315(8):775-787. https://
doi.org/10.1001/jama.2016.0289
11. Miyashita N, Matsushima T, Oka M. The JRS guidelines for the management of community-acquired pneumonia in adults: an update and new recommendations. Intern Med. 2006;45(7):419-428. https://doi.org/10.2169/internalmedicine.45.1691
12. The Japanese Respiratory Society. Committee for the JRS Guidelines in Management of Pneumonia in Adults. The JRS Guidelines for the Management of Pneumonia in adults. 2017; Japanese.
13. Wunderink RG, Niederman MS, Kollef MH, et al. Linezolid in methicillin-resistant Staphylococcus aureus nosocomial pneumonia: a randomized, controlled study. Clin Infect Dis. 2012;54:621-629. https://doi.org/10.1016/j.ymed.2012.08.055
14. Ministry of Health, Labour and Welfare. Laws and Regulations Pertaining to the Certification of Nursing care needs.
15. Van Boeckel TP, Gandra S, Ashok A, et al. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14(8):742-750. https://doi.org/10.1016/s1473-3099(14)70780-7
16. World Health Organization. WHO report on surveillance of antibiotic consumption: 2016-2018 early implementation. Geneva: WHO. 2018.
5, 2023.
17. Falcone M, Paul M, Yahav D, et al. Antimicrobial consumption and impact of antimicrobial stewardship programmes in longterm care facilities. Clin Microbiol Infect. 2019;25(5):562-569. https://doi.org/10.1016/j.cmi.2018.07.028
18. Brown KA, Chambers A, MacFarlane S, et al. Reducing unnecessary urine culturing and antibiotic overprescribing in long-term care: a before-and-after analysis. CMAJ Open. 2019;7(1):E174-E181. https://doi.org/10.9778/cmajo.20180064
19. Marra F, McCabe M, Sharma P, et al. Utilization of Antibiotics in Long-Term Care Facilities in British Columbia, Canada. J Am Med Dir Asso. 2017;18(12):1098.e1-1098. e11. https://doi.org/10.1016/j.jamda.2017.09.018
20. Mayne S, Sundvall PD, Gunnarsson R. Confusion Strongly Associated with Antibiotic Prescribing Due to Suspected Urinary Tract Infections in Nursing Homes. J Am Geriatr Soc. 2018;66(2):274-281. https://doi.org/10.1111/jgs.15179
21. Thornley T, Ashiru-Oredope D, Normington A, et al. Antibiotic prescribing for residents in long-term-care facilities across the UK. J Antimicrob Chemother. 2019;74(5):1447-1451. https://doi.org/10.1093/jac/dkz008
22. Kalil AC, Metersky ML, Klompas M, et al. Management of adults with hospital-acquired and ventilator-associated pneumonia: 2016 clinical practice guidelines by the Infectious Diseases Society of America and the American Thoracic Society. Clin Infect
Dis. 2016;63(5):e61-111. https://doi.org/10.1093/cid/ciw353
23. Bartlett JG. How important are anaerobic bacteria in aspiration pneumonia: when should they be treated and what is optimal therapy. Infect Dis Clin North Am. 2013;27(1):149-155. https://doi.org/10.1016/j.idc.2012.11.016
24. Asai N, Ohashi W, Watanabe H, et al. Efficacy and validity of guideline-concordant treatment according to the JRS guidelines for
25. Shelley S Magill, Erin O’Leary, Kainer MA, et al. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals. JAMA Netw Open. 2021;4(3):e212007. https://doi.org/10.1001/jamanetworkopen.2021.2007
26. Madaras-Kelly KJ, Burk M, Caplinger C, et al. Pneumonia Duration of Therapy Medication Utilization Evaluation Group. Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: results of a national medication
utilization evaluation. J Hosp Med. 2016;11:832-839.
27. Magill SS, O’Leary E, Ray SM, et al. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals. JAMA Netw Open. 2021;4(3):e212007. https://doi.org/10.1001/jamanetworkopen.2021.2007
28. Dean NC, Bateman KA, Donnelly SM, et al. Improved clinical outcomes with utilization of a community-acquired pneumonia guideline. Chest. 2006;130(2):794-799. https://doi.org/10.1016/j.jemermed.2006.11.012
29. Frei CR, Attridge RT, Mortensen EM, et al. Guideline-concordant antibiotic use and survival among patients with communityacquired pneumonia admitted to the intensive care unit. Clin Ther. 2010;32(2):293-299. https://doi.org/10.1016/j.
clinthera.2010.02.006
30. Menendez R, Torres A, Zalacain R, et al. Guidelines for the Treatment of Community-acquired Pneumonia: Predictors of Adherence and Outcome. Am J Respir Crit Care Med. 2005;172:757-762.
31. Tellado JM, Sen SS, Caloto MT, et al. Consequences of inappropriate initial empiric parenteral antibiotic therapy among patients with community-acquired intra-abdominal infections in Spain. Scand J Infect Dis. 2007;39(11-12):947-955. https://
doi.org/10.1080/00365540701449377
32. Marquet K, Liesenborgs A, Bergs J, et al. Incidence and outcome of inappropriate in-hospital empiric antibiotics for severe infection: a systematic review and meta-analysis. Crit Care. 2015;19(1):63. https://doi.org/10.1186/s13054-015-0795-y
33. Tefera GM, Feyisa BB, Kebede TM. Antimicrobial use-related problems and their costs in surgery ward of Jimma University Medical Center: Prospective observational study. PLoS One. 2019;14(5):e0216770. https://doi.org/10.1371/journal.
pone.0216770
34. Chastre J, Wolff M, Fagon JY, et al. Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults: a randomized trial. JAMA. 2003;290:2588-2598. https://doi.org/10.1201/9780429316944-86
35. Lan SH, Lai CC, Chang SP, et al. Five-day antibiotic treatment for community-acquired bacterial pneumonia: A systematic
review and meta-analysis of randomized controlled trials. J Glob Antimicrob Resist. 2020;23:94-99. https://doi.org/10.1016/j.jgar.2020.08.005
36. Han X, Liu X, Chen L, et al. Disease burden and prognostic factors for clinical failure in elderly community acquired pneumonia patients. BMC Infect Dis. 2020;20(1):668. https://doi.org/10.21203/rs.3.rs-21428/v1
37. Tansarli GS, Mylonakis E. Systematic review and meta-analysis of the efficacy of short-course antibiotic treatments for community-acquired pneumonia in adults. Antimicrob Agents Chemother. 2018;62(9):e00635. https://doi.org/10.1128/
aac.00635-18
the managements of pneumonia in adults updated in 2017 for nursing and healthcare-associated pneumonia. A propensitymatching score analysis. J Infect Chemother. 2022;28(1):24-28. https://doi.org/10.1016/j.jiac.2021.09.007
Article Sidebar
Published
Sep 27, 2023
Article Details
How to Cite
1.
Investigation of antimicrobial therapy for aspiration pneumonia in elderly nursing homes: a retrospective observational study in Japan. Pharm Pract (Granada) [Internet]. 2023 Sep. 27 [cited 2024 Oct. 4];21(3):1-10. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/2849
Section
Original Research
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
How to Cite
1.
Investigation of antimicrobial therapy for aspiration pneumonia in elderly nursing homes: a retrospective observational study in Japan. Pharm Pract (Granada) [Internet]. 2023 Sep. 27 [cited 2024 Oct. 4];21(3):1-10. Available from: https://www.pharmacypractice.org/index.php/pp/article/view/2849