Multivariate analysis of prognostic factors in patients with pulmonary actinomycosis

Abstract

BackgroundThere have been few studies of pulmonary actinomycosis, which is an uncommon anaerobic infection. Consequently, the optimal therapeutic regimen, appropriate duration of treatment, long-term prognosis, and factors predicting prognosis are not well established.MethodsWe retrospectively reviewed the medical records of histopathologically confirmed cases of pulmonary actinomycosis seen between November 2003 and December 2012.ResultsThe study included 68 patients with a mean age of 58.4 ± 11.6 years. Of the 68, initial surgery was performed in 15 patients (22.1%), while the remaining 53 (77.9%) received antibiotic therapy initially. In the initial antibiotic group, 45/53 (84.9%) were cured without relapse (median antibiotic duration 5.3 months). 5/53 (9.4%) patients were refractory medically (median antibiotic duration 9.7 months), and 3/53 (5.7%) experienced a recurrence (median time to relapse 35.3 months). In the initial surgery group, 14/15 (93.3%) were cured and treatment failure occurred in one (6.7%). In the multivariate analysis, the absence of an antibiotic response at 1 month was the only independent factor associated with a poor treatment outcome, with an adjusted odds ratio of 49.2 (95% CI, 3.34–724.30). There was no significant difference in treatment outcome based on the size of the parenchymal lesion, comorbidities, whether intravenous antibiotics were used, antibiotic therapy duration, or whether the initial treatment was surgical.ConclusionsAntibiotic treatment with or without surgery was effective for treatment of pulmonary actinomycosis. Nevertheless, treatment failure or recurrence occurred in a considerable proportion of patients, especially those resistant to the initial antibiotic treatment.

Actinomycosis: An infrequent disease in renal transplant recipients?

“…16 In 2000, Russo 22 recommended high doses of intravenous penicillin for 2-6 weeks, followed by high doses of oral penicillin for 6-12 months to prevent relapse. Several authors [23][24][25][26] are now in agreement on a recommendation for a shorter treatment and a lower dose in the case of an early diagnosis.…”

“…Antibiotic treatment duration has to be adjusted to the location of infection, the severity of the lesion and patient history. Early treatment of co‐infecting bacteria should take priority . Thus, Park and Smith recommend starting treatment with amoxicillin and clavulanic acid to extend the antibiotic spectrum.…”

“…Early treatment of co‐infecting bacteria should take priority . Thus, Park and Smith recommend starting treatment with amoxicillin and clavulanic acid to extend the antibiotic spectrum. If the patient has a penicillin allergy, they can be treated with tetracycline or cephalosporin .…”

“…Surprisingly, surgery for drainage is more common in renal transplant recipient than in the general population. However, surgery should be avoided, except in cases of hemoptysis or abscess, because it often leads to a large surgery. In Pierre's study, surgery did not change the duration of antibiotic treatment.…”

Actinomycosis after allogeneic hematopoietic stem cell transplantation despite penicillin prophylaxis

“…Surgical resection resulted in shorter treatment durations in 40 thoracic actinomycosis cases with a median of 3.1 (range, 1.1-5.8) months in case of surgery vs. 5.1 (range, 4-6.1) months otherwise (10). After an IV induction phase of 7-14 days, thoracic actinomycoses were resolved with antibiotic courses ranging from 6 weeks to 5.3 months, regardless of surgical resection (1,2,(11)(12)(13)(14). Finally, although occurring in highly immunocompromised patients, these cases underline the favorable outcome when the disease is recognized and appropriate treatment is given.…”