Cefoperazone-sulbactam superior to piperacillin-tazobactam for severe CAP

Treatment with cefoperazone-sulbactam demonstrates similar efficacy to that of piperacillin-tazobactam in adult patients with severe community-acquired pneumonia (SCAP), according to a study. However, after adjusting for disease severity, cefoperazone-sulbactam appears superior to piperacillin-tazobactam.

“Our study shed light on the clinical efficacy of cefoperazone-sulbactam versus piperacillin-tazobactam in the treatment of SCAP,” said Dr Hsu Yuan Chen from China Medical University Hospital, Taichung City, Taiwan, in his presentation at ERS Congress 2023 held in Milan, Italy. “The results support the potential superiority of cefoperazone-sulbactam [over piperacillin-tazobactam].”

Chen and his colleagues extracted clinical data from the BATTLE study, which examined the efficacy and safety of cefoperazone-sulbactam in the management of SCAP and nosocomial pneumonia. They then conducted this multicentre, retrospective study from 1 March 2018 to 30 May 2019 at eight medical centres and one regional hospital in Taiwan.

A total of 815 patients with SCAP were enrolled, of whom 343 received cefoperazone-sulbactam and 472 piperacillin-tazobactam for the treatment of SCAP, hospital-acquired pneumonia, and ventilator-associated pneumonia. [Medicine (Baltimore) 2023;102:e34284]

Patients in the cefoperazone-sulbactam group showed higher scores in the Charlson Comorbidity Index than those in the piperacillin-tazobactam group (6.20 vs 5.72; p=0.009). The primary endpoints of clinical cure rates and effectiveness for patients on cefoperazone-sulbactam and piperacillin-tazobactam were 84.2 percent vs 80.3 percent (p=0.367) and 85.4 percent vs 83.3 percent (p=0.258), respectively.

“The clinical efficacy of cefoperazone-sulbactam in the treatment of adult patients with SCAP is comparable to that of piperacillin-tazobactam,” said Chen. [ERS 2023, abstract 4866]

In terms of mortality, the overall rates were also similar between the two treatment groups: 55 patients (16 percent) with cefoperazone-sulbactam and 84 (17.8 percent) with piperacillin-tazobactam (p=572).

Risk factors

Predictors of an increased risk of death were patient indication of prior antibiotic usage, use of proton pump inhibitor drugs, need for tube feeding, nonambulatory status, CAP severity, recent hospitalization, dialysis, and immunosuppression. [Clin Infect Dis 2019;68:1080-1088; Am J Respir Crit Care Med 2013;188:985-995]

In addition, the risk factors for P aeruginosa CAP included male sex, presence of chronic airway disease, need for vasoactive drug or mechanical ventilation, higher pneumonia severity index, and prior P aeruginosa colonization. [Chest 2016;150:415-425]

For SCAP patients with P aeruginosa, extended-spectrum β-lactamase Enterobacteriaceae pathogens, the only risk factor identified was chronic pulmonary disease, which was consistent with the previous study. [Chest 2016;150:415-425]

Superior therapy

Notably, following adjustments for disease severity status, the current results suggested that cefoperazone-sulbactam was superior to piperacillin-tazobactam.

“A significant finding in our study was the superior clinical cure rate of cefoperazone-sulbactam compared with piperacillin-tazobactam after adjusting for disease severity,” Chen said. “This suggests that cefoperazone-sulbactam could potentially be a more effective treatment option for SCAP.”

SCAP is a significant cause of morbidity and mortality in patients, carrying a high mortality rate from 17 percent to 50 percent despite improving therapies.

“Cefoperazone-sulbactam, an effective broad-spectrum antibacterial agent, targets respiratory pathogens and multidrug-resistant organisms, including Enterobacteriaceae members, P aeruginosa, and other nonglucose-fermenting gram-negative bacilli, and anaerobes,” the researchers said.

“Our research indicates that cefoperazone-sulbactam holds promise as an effective treatment for SCAP,” Chen said.